Modified Damus–Kaye–Stansel Anastomosis to Prevent Coronary Obstruction Between the Great Arteries

The conventional Damus–Kaye–Stansel (DKS) procedure may cause coronary artery compression when the coronary arteries are situated between the great arteries. We have performed a modified DKS procedure utilizing a “flap-bridging technique,” in which an inverted U-shaped flap incised from the aorta is bridged to the main pulmonary trunk, creating sufficient space between the great arteries in an 8-month-old boy who was a Fontan candidate with congenitally corrected transposition of the great arteries. This modified approach yielded favorable outcomes without coronary events and can effectively prevent coronary obstruction in cases where the coronary arteries run between the great arteries.