[A successful modified Aubert procedure for transposition of the great arteries with a special coronary artery...

Transplantation of the coronary arteries is an essential and critical part of the arterial switch operation, which is considered to be the treatment for most neonate with transposition of the great arteries. The presence of an intramural segment of coronary arteries, close coronary ostia adjacent to each other increase the risk of coronary twisting and kinking after transplantation. This case has an unusual coronary anatomy characterized by two coronary ostia arising from the same aortic cusp, intramural segment in a proximal part of the left anterior descending coronary artery (LAD) and slit-like narrow ostium of LAD. This neonate was successfully operated on using Aubert modification which is the arterial switch operation without coronary transplantation. In this method, the reconstruction of the new pulmonary trunk must be accomplished by direct anastomosis of the posterior wall in order to allow for a growth of pulmonary artery. Because of a patch retraction which was used to create its anterior wall, pulmonary stenosis may occur. In case of reoperation for pulmonary stenosis, we have only to enlarge the anterior part of the pulmonary artery to take down the stenosis. Coronary transplantation should be avoided in TGA neonate with an unusual coronary anatomy including intramural coronary artery and closed coronary ostia adjacent to each other.