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Imai technique for management of the coronary arteries arising from a solitary sinus in discordant ventriculo-arterial connections

management, during the arterial switch procedure, of coronary arteries which arise from a solitary aortic sinus, but few of these have been evaluated subsequently by post-operative angiography. The unusual circumstances of our patient provided an opportunity for such investigation. A 9.6 kg Sudanese girl presented at thirty-nine months of age with profound cyanosis which had been present from birth. Echocardiography demonstrated concordant atrioventricular and discordant ventriculo-arterial connections, with a large subaortic ventricular septal defect and an intact atrial septum. The systolic gradient across the defect was only 36 mmHg, with bidirectional shunting, suggesting that pressure in the pulmonary arteries was at least 2/3 of systemic pressure. In view of socio-economic constraints, and the likelihood of irreversible pulmonary vascular disease, a palliative arterial switch operation was performed without preoperative cardiac catheterization. At operation, the aorta lay anterior and slightly to the right of the pulmonary trunk. The coronary arteries arose from a single orifice in the left-hand facing sinus (sinus #2), with the anterior interventricular and circumflex branches passing in front of the arterial pedicles. Using the technique described by Imai in Japanese,1 and cited by Mee,2 the aorta and pulmonary trunk were joined together above the coronary arterial orifice, and the wall of the non-facing aortic sinus was rotated counterclockwise into the facing sinus on a small hinge above the valvar commissure (Fig. 1). This created a pocket around the coronary arterial origin, which was then joined to the distal aorta, providing a wide tunnel to the coronary artery, which remained attached to the native aortic root. After the Lecompte manoeuvre, the posterior wall of the distal pulmonary trunk was Cardiol Young 2001; 11: 578–579 © Greenwich Medical Media Ltd. ISSN 1047-9511