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The results of surgical atrial septectomy alone, septectomy with pulmonary artery banding, and septectomy with shunting procedures in 105 patients are reported. There were 82 survivors with eight deaths directly related to surgery, seven related to specific preoperative complications, and eight resulting from associated cardiac malformations. Excellent improvement in arterial oxygen saturation was achieved and maintained over an extended period of time in the majority of survivors. Although balloon septostomy has proved to be a helpful palliative maneuver in patients with TGA, 34 children who had this procedure later required surgical septectomy. A late fall in arterial oxygen saturation was often indicative of diminishing pulmonary blood flow on the basis of increasing pulmonary stenosis or pulmonary vascular obstructive disease.