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©2013 UpToDate ® Print Email 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, neoaortic 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 neoaorta. (E) The pulmonary artery is brought anterior to the aorta (Lecompte maneuver). Anastomosis of the proximal neoaorta is shown. (F) The coronary donor sites are filled with autologous pericardial patches. A single U-shaped patch (F) or two separate patches (G) may be used. (H) Anastomosis of the proximal neopulmonary artery and the distal pulmonary artery. Reproduced from: Castaneda AR. Anatomic correction of the transposition of the great arteries at the arterial level. In: Surgery of the Chest, Sabiston DC Jr, Spencer FC (Eds), WB Saunders, Philadelphia 1990. Illustrations used with the permission of Elsevier Inc. All rights reserved.