Modification of the arterial switch procedure in the presence of a rare coronary arterial pattern

Numerous techniques have been described for translocation of the coronary arteries in the setting of the arterial switch procedure. In the case we describe, the close alignment to the aortic and the pulmonary wall of the main stem supplying the left anterior descending and circumflex arteries, and dual origin of this vessel and the right coronary artery from sinus #2, required an individual approach. After taking down the main stem feeding the left anterior descending and circumflex arteries in the usual manner, we opted for a connection maintaining the artery in its existing site, and punched a hole into the neo-aorta just in front of the coronary orifice. We then used a piece of glutaraldehyde-preserved pericardium as a hood, anastomosing the right coronary artery to the new aorta by means of the usual trap door technique.