An experience with twenty-one patients undergoing emergency palliative surgery for transposition of the great vessels with pulmonary overcirculation is presented. Banding of the pulmonary artery was performed as the only operative procedure in three patients and as the initial operative procedure in six patients. All but one failed to survive operation. The creation of an atrial septal defect by the Blalock-Hanlon operation was performed as the only operative procedure in fourteen patients with four deaths and a satisfactory late clinical result in all survivors. Thus, while the over-all results of palliative surgery for transposition are far from satisfactory, those patients suffering predominantly from severe cyanosis may expect a good result from a Blalock-Hanlon operation in terms of exercise tolerance, growth and development and the ease of subsequent medical management. Those patients suffering predominantly from associated cardiac defects with massive pulmonary overcirculation and only minimal cyanosis are poor candidates for palliative surgery and must be considered for total correction if survival is to be obtained.
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