Until recently, the anatomic variability of the coronary arteries in hearts with transposition of the great arteries (TGA) was only of academic interest. Shaher and Puddu  described the multiple variations in the origin and epicardial course of the coronary arteries as early as 1966. This marked diversity has been confirmed in other pathologic [2–5] and surgical series [6–19]. Additional classification schemes have been employed with the hope of simplifying the description of the many anatomic patterns, most notably by Gittenberger-de Groot et al. , Yacoub and Radley-Smith , and Pasquini et al.  and Mayer et al. .
With the current widespread application of the arterial switch operation for repair of TGA (and transposition-like forms of double-outlet right ventricle), detection of these anatomic variations has become clinically important. The improvement in surgical technique for the transfer of the coronary arteries to the neoaorta has been paralleled by the enhanced diagnostic capabilities of two-dimensional echocardiography [22,23] and modified aortography [24,25]. Recent reports detailing the outcome of the arterial switch operation indicate that coronary artery distribution probably plays an important role in the immediate and ultimate success of this surgical approach [7,9,16,17,26].
This article reviews 1) the embryology and numerous anatomic classification schemes proposed in the literature, 2) the various diagnostic methods used for the detection of coronary artery patterns, 3) the techniques of surgical transfer during the arterial switch operation, and 4) the midterm results of transfer of the coronary arteries in the neonate.