The congenital coronary lesion associated with minimal or absent clinical manifestations and nearly normal life expectancy is:

D. Congenital origin of the right coronary artery from the pulmonary artery.

DISCUSSION: Clinical manifestations of congenital origin of the right coronary artery from the pulmonary artery are usually minimal or absent. This malformation is thought to have been associated with death. The oldest reported patient with this malformation died at age 90 years from unrelated problems.