Meticulous transfer of coronary arteries is of crucial importance in
transposition of great arteries and determines the success of the switch
procedure. This report describes a coronary anatomy consisting of four
separate ostia from the two facing sinuses in a six-month-old infant
presenting with d-transposition of great arteries and ventricular septal
defect. Being a rare coronary arterial pattern not described in previous
coding systems, the surgeon would do well to be aware of this
possibility while performing the switch procedure.