Background-Transposition of the great arteries (TGA) is a life-threatening malformation in neonates, but it is amenable to complete repair. Prenatal detection, diagnosis, and early management may modify neonatal mortality and mortality. Methods and Results-Preoperative and postoperative morbidity and mortality were compared in 68 neonates with prenatal diagnosis and in 250 neonates with a postnatal diagnosis of TGA over a period of 10 years. The delay between birth and admission was 2Ϯ2.8 hours in the prenatal group and 73Ϯ210 hours in the neonatal group (PϽ0.01). Clinical condition at arrival, including metabolic acidosis and multiorgan failure, was worse in the neonatal group (PϽ0.01). Once in the pediatric cardiology unit, the management was identical in the 2 groups (atrioseptostomy, PGE 1 infusion, operation date). Preoperative mortality was 15 of 250 (6%; 95% CI, 3% to 9%) in the neonatal group and 0 of 68 in the prenatal group (PϽ0.05). Postoperative morbidity was not different (25 of 235 versus 6 of 68), but hospital stay was longer in the neonatal group (30Ϯ17 versus 24Ϯ11 days, PϽ0.01). In addition, postoperative mortality was significantly higher in the neonatal group (20 of 235 versus 0 of 68, PϽ0.01); however, the known risk factors for operative mortality were identical in the 2 groups. Conclusions-Prenatal diagnosis reduces mortality and morbidity in TGA. Prenatal detection of this cardiac defect must be increased to improve early neonatal management. In utero transfer of fetuses with prenatal diagnosis of TGA in an appropriate unit is mandatory. (Circulation. 1999;99:916-918.)

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Congenital ventricular diverticulum and aneurysm are two distinct entities, with different histologic and morphologic characteristics and outcomes. Assessment of these differential characteristics is of importance for prenatal counseling.

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Non-surgical insertion of the PV is possible without any major complications. This new technique may have an important role in the management of conduit obstructions and pulmonary regurgitation.