Modified Nikaidoh procedure in a patient with transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction with unusual coronary anatomy

The Rastelli operation has been the most common procedure for the repair of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction. A relatively recent approach is the Nikaidoh procedure. Despite the fact that it seems promising, the operation lacks long-term follow-up data. It has been postulated that patients with anomalous coronary arteries are high-risk candidates for the Nikaidoh procedure and its modifications. In this report, we present the case of a patient with transposition of the great arteries with remote restrictive ventricular septal defect and left ventricular outflow tract obstruction with coronary anomaly – with the right coronary artery originating from the left anterior descending coronary artery and crossing the right ventricular outflow tract – who underwent successful modified Nikaidoh operation.