The presence of an obstructed aortic arch in patients with transposition, or the Taussig-Bing variant of double outlet right ventricle, presents a formidable surgical challenge. Over the years, there have been several controversies with respect to primary versus staged repair, the best technique for reconstruction of the aortic arch, and whether to use circulatory arrest or antegrade regional cerebral perfusion. In this review, I will address all these issues and describe my favoured surgical approach at The Montreal Children's Hospital, namely the single-stage arterial switch operation with concomitant repair of the aortic arch with a patch fashioned from a pulmonary homograft, all conducted using antegrade regional cerebral perfusion.