Should we standardise the pre-operative management of babies with completetransposition?

Background. Complete transposition is the most common form of neonatal cyan otic heart disease. The management of this condition has changed markedly i n the last decade and there appears to be a significant variation between c entres in terms of pre-operative management. Objectives/Methods: We surveye d all paediatric cardiac surgical centres in the United Kingdom regarding p re-operative management, particularly performance and timing of balloon atr ial septostomy and aortogram, imaging techniques used and discharge prior t o surgery. Results: There is significant variation in pre-operative managem ent: 10 centres now perform septostomy outside the catheter lab and 11 with out general anaesthesia. Eight centres use echo control only and only 3 per form routine aortograms. Three centres do not perform routine septostomy. T he most common age for arterial switch was at 1-2 weeks, but some routinely performed this procedure up to 1 month of age and others aim for arterial switch before one week of age. Only 3 centres routinely discharge patients between septostomy and switch. Conclusions. Despite a trend towards echo gu ided septostomy and earlier arterial switch there is still considerable var iation in early management of patients with transposition of the great arte ries. Debate within the profession leading to a more standardised pre-opera tive management strategy would protect both the patient and the doctor invo lved in the care of children with complete transposition.