Operative schema. The PA was transected. The LCA ostium was cut out from the posterior PA wall to obtain a Carrel patch, with a cuff diameter of 8 mm. A graft was anastomosed to the coronary cuff with 5–0 polypropylene sutures. The graft was directed toward the right lower side of the aorta through the transverse sinus of the pericardium, and its proximal side was then anastomosed to an opening prepared on the right lateral side of the ascending Ao with 5–0 polypropylene sutures. The PA was directly reconstructed with 4–0 polypropylene sutures. Ao, aorta; PA, pulmonary artery; RCA, right coronary artery; LCA, left coronary artery. Graft: an 8-mm HEMASHIELD graft (MAQUET Cardiovascular LLC, San Jose, CA, USA); anterior, anterior semilunar cusp; left, left semilunar cusp; right, right semilunar cusp.