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The truncus arteriosus communis is a very complex congenital cardiac malformation occurring in less than 1% of all congenital heart disease patients. Early repair remains one of the most challenging procedures in congenital cardiac surgery. Due to improvement in surgical reconstruction strategies over the past years, there is an acceptable short and long-term survival for those patients. However, each new case represents a “high mountain to climb” in ambition to achieve physiological repair with acceptable hemodynamic and a good long-term survival. We therefore present a very special case with anomalous origin and intramural course of the right coronary artery.
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