Figure 2:

Schematic stepwise representation of the modified Yacoub aortocoronary flap technique. Right anterior-related position of the aorta compared to the pulmonary artery with aligned commissures of the semilunar valves and coronary artery with intramural course. A surgical incision is made around both coronary ostia to create a coronary flap (A). Rotation of the the coronary flap to align the ostia with the neo-aorta in the horizontal plane (maximum 45°) with anastomosis of the basis of the coronary artery button to the neo-aorta (B). The aorta is positioned above the pulmonary valve and pulmonary trunks and a small longitudinal aortic incision has been made (C) for the creation of the aortocoronary flap using a pericardial hood to connect the coronary flap to the neo-aorta (D) and to accomplish the arterial switch (E).