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Anatomical correction of complete transposition of the great arteries has the potential advantage over intra-atrial repair in that the left ventricle becomes the systemic pump. To investigate the importance of this, we evaluated right and left ventricular function in 21 patients after anatomical correction and in 21 patients after Mustard or Senning operations. First-pass and equilibrium-gated radionuclide angiography were used to measure right and left ventricular ejection fractions between 17 and 78 (mean, 47) months after anatomical correction and between 3 and 187 (mean, 67) months after intra-atrial repair. The mean age of the patient groups at the time of study was 52 and 84 months, respectively. The right ventricular ejection fraction ranged from 35% to 78% (mean, 58%) in patients after anatomical correction and from 27% to 68% (mean, 51%) after intra-atrial repair (p=0.066). The left ventricular ejection fraction ranged from 39%1 to 74% (mean, 58%) after anatomical correction and from 35% to 74% (mean, 58%) after intra-atrial repair (p=0.86). The mean right and left ventricular ejection fractions of both groups were significantly lower than those of normal children. Individuals with systemic ventricular dysfunction were identified after both types of operations; however, symptomatic dysfunction occurred only after intra-atrial repair (p =0.24). (Circulation 1990;82:808-816) T he occurrence of systemic ventricular dysfunction in a significant number of patients after Mustard and Senning operations1-3 has been documented. The cause of this dysfunction remains uncertain. It has been suggested that the right ventricle is unable to sustain systemic pressure loads in the long-term because of various morphological features4 or preoperative hypoxemia and intraoperative factors.5 Some or all of these factors may influence the left ventricle also. This has stimulated the development of anatomical correction for complete transposition of the great arteries (TGA ventricular function after anatomical correction,7-10 but little information is available on ventricular function in the medium-term.11'12 The purpose of this study was to investigate right and left ventricular function in patients who had undergone anatomical correction or intra-atrial repair operations for TGA by the same investigative methods for both groups of patients. We attempted to identify the factors contributing to right ventricular dysfunction after Mustard and Senning operations and to investigate whether left ventricular dysfunction occurred after anatomical correction. Methods Anatomical CorrectionTwenty-one patients who had undergone anatomical correction of TGA at Harefield Hospital were studied. The age of the patients at the time of the study ranged from 17 to 85 months (mean, 51.8 months). The studies were performed between 17 and 78 months after operation (mean, 47 months).