Arterial switch operation with separate coronary arteries arising from a single aortic sinus

In some patients, the coronary arteries originate in a single aortic sinus, and this anatomical configuration is regarded as a significant risk factor in the arterial switch operation for transposition of the great arteries. In these cases, the coronary transfer technique has to be individualized to suit the coronary anatomy (i.e., a single ostium or separate ostia). Since 2001, we have operated on three patients who had separate coronary arteries arising from a single sinus. In one, coronary transfer was carried out using the double-button technique and, in the other two, using the aortocoronary flap technique. The aortocoronary flap procedure gave excellent results in patients with this coronary artery configuration.