The arterial switch operation has become the preferred surgical procedure for the management of simple and complex transposition, defined on the basis of concordant atrioventricular but discordant ventriculo-arterial connections, with excellent results over the short-term, and thus far over the long-term. When transposition is associated with a ventricular septal defect, and there is additional obstruction within the left ventricular outflow tract, the complexity of the surgical repair is increased, and the surgical options are not as attractive.