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Though the outlook for children with transposition of the great arteries has been transformed by modern methods of treatment, the initial improvement after balloon septostomy may raise false hopes. A relatively longfollow-up of thefirst 65 consecutive cases treated between November 1966 and December I969 shows the serious risks to which these infants are exposed: 32 children have died, 5 during or immediately after septostomy; I8 needed further septostomies and 12 of these have died. The influence of coexistent heart lesions has been analysed and the effect on pulmonary vascular resistance assessed, demonstrating that a ventricular septal defect or a persistent ductus arteriosus does not always need surgical treatment to prevent pulmonary hypertension. Intravascular thrombosis was a major problem causing serious damage to brain, kidneys, and intestine, and 9 deaths. Mustard's operation produced immediate improvement but the long-term prognosis has still to be assessed.Balloon atrial septostomy (Rashkind and Miller, I966) and subsequent surgical correction (Mustard, I964) have revolutionized the management of infants with transposition of the great arteries. In this paper we review the first 65 infants with transposition to be treated by balloon septostomy at Birmingham Children's Hospital. The babies were admitted between November I966 and December I969; cases of tricuspid atresia have been excluded.Balloon septostomy is quick, it causes little disturbance, and usually gives satisfactory immediate results. When successful there is an obvious improvement in the child's colour, a rise in oxygen saturation in right atrial blood, abolition of pressure gradient between the two atria, and a hole large enough to pass the inflated balloon in either direction without difficulty. But initial improvement is not always maintained, and a review of patients followed up for I to 4 years or more shows the hazards to which these children are exposed especially in the interval between septostomy and Mustard's operation. ResultsRepeat septostomy A second septostomy (Table i) was needed on i8 occasions -by balloon in I3 and operation in 5. Six of the

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Forty-one children with osteogenesis imperfecta have been reviewed. A minority (7/41) showed small metaphyseal fractures, resembling those seen in non-accidental injury, but in all of these there was obvious generalized bone disease so that confusion with non-accidental injury did not occur.

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