Transposition of the great arteries with posterior aorta: A rare entity

A rare but historically significant variant of transposition of the great arteries (TGA) was first identified in 1971. A posterior and rightward-positioned aorta, an underdeveloped subaortic conus, and a well-developed subpulmonary conus characterize this entity. The relationship of the great vessels mimics that of normally related great arteries, with the pulmonary artery positioned anteriorly and the aorta located posteriorly. This report describes a patient with such a variant of TGA, associated with a ventricular septal defect, who underwent a successful arterial switch operation. Despite the unusual positioning of the great arteries, coronary artery transfer and pulmonary artery anastomosis were effectively performed. Although published literature advises against performing LeCompte's maneuver in such anatomy, we performed the maneuver in this case with anterior and posterior looping coronaries to protect the proximal coronary arteries from excessive stretch.