case_images: PMC10797325_01
case_images: PMC10797325_02
case_images: Excerpt from original operation in 1996 the detailing transfer of coronary arteries to current positions. Source: Mater Private Network.
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case_images: PMC10797325_02_ytad641f1.jpg
case_images: ytad641-F1
case_images: On careful scrutiny of the arterial switch operative notes, there was a description of a transfer of a 'left coronary ostium' thought to supply the right coronary artery (RCA), left anterior descending (LAD), and LCx from the native-aortic root to neo-aortic root 'sinus 1' and 'sinoatrial (SA) node branch' from the native-aortic root to 'sinus 2' (Figure 1).
case_images: cardiac magnetic resonance [EF (50%)] showing late gadolinium enhancement in the basal anterolateral and inferolateral walls (white arrow) (left). Chest radiograph showing subcutaneous implantable cardioverter defibrillator insertion (right). Source: Mater Private Network.
case_images: ytad641f2.jpg
case_images: PMC10797325_04_ytad641f2.jpg
case_images: ytad641-F2
case_images: S-ICD was implanted without issue and defibrillation thresholds were tested and satisfactory (Figure 2).
case_images: CT shows anomalous origin of the left circumflex artery arising from the pulmonary artery (left arrow) (left). CT demonstrating anomalous left circumflex artery as well as the right coronary artery ( top arrow) and left anterior descending (right arrow) arising from the right coronary cusp (right). Source: Mater Private Network.
case_images: ytad641f3.jpg
case_images: PMC10797325_02_ytad641f3.jpg
case_images: ytad641-F3
case_images: LAD (Figure 3 yellow arrow) and RCA (Figure 3 red arrow). LCx was seen arising from the main pulmonary artery (mPA) with co-located surgical clips (Figure 3 white arrows).
case_images: Electrophysiology study demonstrating inducible broad-complex tachycardia with double ventricular extrasystoles origin requiring termination. Source: Mater Private Network.
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case_images: PMC10797325_02_ytad641f4.jpg
case_images: ytad641-F4
case_images: PMC10797325_03
case_images: Anteroposterior caudal projection (CAU 20 deg) contrast opacifying left anterior descending, Retrogradely filling left circumflex artery, and emptying into the main pulmonary artery (left). Straight right anterior oblique (RAO) projection (RAO 30 deg). Catheter engaged and contrast opacifying right coronary artery predominantly. Ghosting of the left anterior descending (right). Source: Mater Private Network.
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case_images: PMC10797325_03_ytad641f5.jpg
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case_images: LHC showed an anomalous LMS, LAD, and RCA arising from the right coronary cusp all widely patent, with collaterals to the LCx, which retrogradely filled to its os in the mPA. (Figure 5).
case_images: PMC10797325_04
case_images: cardiac magnetic resonance [EF (50%)] showing late gadolinium enhancement in the basal anterolateral and inferolateral walls (white arrow) (left). Chest radiograph showing subcutaneous implantable cardioverter defibrillator insertion (right). Source: Mater Private Network.
case_images: ytad641f2.jpg
case_images: PMC10797325_04_ytad641f2.jpg
case_images: ytad641-F2
case_images: S-ICD was implanted without issue and defibrillation thresholds were tested and satisfactory (Figure 2).