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For the success of anatomical correction of transposition of the great arteries (TGA) it is essential to transfer the coronary ostia to the posterior vessel without undue tension, torsion, or kinking of the proximal coronary arteries or their early branches. This requires thorough understanding of the different modes of origin and early branching of the coronary arteries in TGA. Based on observations made during anatomical correction, a classification of the coronary arteries in TGA is suggested. In type A the right and left coronary ostia arise from the middle of the right and left posterior aortic sinuses and curve forwards to reach the right atrioventricular groove or anterior interventricular groove respectively. In type B both coronary arteries arise by a single ostium, while in type C the two coronary ostia are situated posteriorly, very close to each other, in a position similar to that in type B. The origin of the coronary arteries in type D is similar to that of type A. However, the right coronary artery gives origin to the circumflex coronary artery that curves round the posterior (pulmonary) vessel to reach the atrioventricular groove. In type E the right coronary artery arises in common with the left anterior descending artery from the left posterior sinus, while the circumflex artery arises separately from the right posterior sinus. Three techniques for the transfer of the different types of coronary arteries during anatomical correction are described. [ABSTRACT FROM PUBLISHER]

A rare case of anomalous origin of the right pulmonary artery from the ascending aorta associated with an aortopulmonary window and severe pulmonary hypertension in a 13-year-old girl is reported. The window was closed using a Dacron patch and the continuity between the anomalous vessel and the main pulmonary artery was restored with a tubular Dacron graft. After operation the pulmonary pressure dropped to about one-half of the systemic pressure, and equal perfusion and ventilation of both lungs was demonstrated. Although early recognition and surgical treatment of this condition are mandatory to prevent the onset of irreversible pulmonary vascular disease, the presence of severe pulmonary hypertension did not contraindicate surgical correction in our patient. [ABSTRACT FROM PUBLISHER]

A rare case of anomalous origin of the right coronary artery from the pulmonary artery associated with a large aortopulmonary window in a 4-month-old boy is reported. The right coronary artery is exposed to systemic pressure and carries fairly well-oxygenated blood to the myocardium. Angiographic diagnosis could be difficult because of the simultaneous filling of both great arteries which obscures the origin of the anomalous vessel. Closure of the aortopulmonary window alone could result in acute myocardial ischaemia. A plastic procedure for correction of this association of defects, which should allow normal growth, is described. [ABSTRACT FROM AUTHOR]