Arterial switch operation for transposition of the great arteries

Surgical technique of the arterial switch operation.
(A) Aortic cannula is positioned distally in the ascending aorta, the ductus arteriosus is divided between suture ligatures, and the branch pulmonary arteries are dissected out to the hilum to provide adequate mobility for anterior translocation. The broken lines represent the levels of transection of the aorta and the main pulmonary artery. Marking sutures are placed in the anticipated sites of coronary transfer.
(B) Transection of the great arteries. The left ventricular outflow tract, neo-aortic valve, and coronary arteries are thoroughly inspected.
(C) The coronary arterial buttons are excised from the free edge of the aorta to the base of the sinus of Valsalva.
(D) The coronary buttons are anastomosed to V-shaped excisions made in the neo-aorta.
(E) The pulmonary artery is brought anterior to the aorta (LeCompte maneuver). Anastomosis of the proximal neoaorta is shown.
(F and G) The coronary donor sites are filled with autologous pericardial patches. A single U-shaped patch (F) or 2 separate patches (G) may be used.
(H) Anastomosis of the proximal neopulmonary artery and the distal pulmonary artery.