Aortic re-implantation in a case of anomalous origin of the left coronary artery from the right pulmonary artery in a toddler.

This tutorial  demonstrates correction of the rarest congenital coronary anomaly, anomalous origin of the left coronary artery from the right pulmonary artery (ALCAPA RPA). We present the features of surgical repair in the case of a toddler patient with an associated atrial septal defect.

Anomalous origin of the right coronary artery from the pulmonary artery: surgical re-implantation into the aorta.

Anomalous origin of the right coronary artery from the pulmonary artery is rare (only 200 cases have been reported in total), potentially life-threatening and with an uncertain prognosis. Patient characteristics are only available in half the reported cases. Easy to miss, anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is usually diagnosed in association with concomitant cardiac anomalies.

The Bex-Nikaidoh operation for dextro-transposition of the great arteries with a ventricular septal defect and pulmonary stenosis using an 'oversized' conduit.

We report a case of a 4-month-old infant with dextro (d)-transposition of the great arteries, ventricular septal defect (VSD) and left ventricular outflow tract obstruction previously palliated with a systemic-to-pulmonary shunt. He underwent repair by aortic root translocation with an arterial switch procedure and coronary artery reimplantation (modified Bex-Nikaidoh operation). This case demonstrates that aortic translocation results in a more normal anatomic repair compared with the Rastelli operation.