[Objective] To review our experience in ten years with the diagnosis of children with anomalous origin of the left coronary artery from pulmonary artery (ALCAPA) and to evaluate surgical results and short-middle term outcomes. [Methods] 35 cases of ALCAPA hospitalized between 1998 and 2008 in our center were enrolled. Electrocardiographic and echocardiographic features were compared between the infant group (<1Y, n=18) and the older children group (>1Y, n=17).34 patients were underwent surgical repair and short-middle term outcomes were evaluated. [Results] The diagnosis of ALCAPA was obtained in 27 patients through echocardiography with diagnostical rate of 77%. The presence of abnormal Q wave in lead aVL (26/35), anterior lateral papillary echogenic (28/35) and coronary collateral vessel signals(25/35) were high in both groups(P>0.05). The presence of RCA dilation was lower in the infant group(7) than in the older children(16) group(P <0.05). Cardiac dysfunction was assessed in 16 infants but none in older children.Six collateral anastomosis sites were detected in 23 patients through angiography and the collateral flow pattern was age-dependent.Dual coronary repair was performed in 32 patients and LCA ligation in 2.LV function and mitral regurgitation improved in 22 patients during short-middle term follow-up. [Conclusion] Diagnosis can be established by combination of echocardiography and electrocardioagraphy. Abnormal Q wave in lead aVL, anterior lateral papillary echogenic and collateral vessel signals were the most valuable features to predict ALCAPA. Survival rate of surgical repair was satisfactory. Dual coronary repair was preferred with good short-middle term outcomes.