The anomalous origin of left coronary artery from pulmonary artery is a rare congenital coronary anomaly accounting for 0.24% of congenital heart diseases. Most infants die within first year of life. 10-20% of patients remain asymptomatic and survives to adulthood. Survival beyond infancy depends on development of adequate collaterals. We present a case of incidentally detected ALCAPA in a cardiac patient who presented for non cardiac surgery. The patient was posted for a laparoscopic cholecystectomy, urgently indicated in view of a past episode of gallstone pancreatitis. We describe the anesthetic management and the goals to maintain such patient’s perioperatively. Maintenance of adequate coronary perfusion is key in the management of ALCAPA patient presenting for cardiac or non cardiac surgery. Goals in anesthetic management includes to maintain systemic oxygenation, prevent increase in myocardial oxygen demand, maintain normal SVR, avoid fall in PVR which can cause coronary steal and optimize systemic venous oxygen tension as a surrogate of cardiac output. The role of perioperative ECHO in detecting volume status as also changes in contractility and the measurement of biomarkers to detect occult myocardial damage is also topical. We discuss some of these aspects including the choices for laparoscopic vs. Open intervention and the aspects of anesthetic management for laparoscopy pertinent to this case besides making the pitch for wider availability and training in perioperative ECHO.