conceived of, and attempted, the anatomical repair (arterial switch) for d-tga in the early 1950s. his few attempts were unsuccessful due to technical difficulties posed by the translocation of the coronary arteries, and the idea was abandoned. swedish cardiac surgeon åke senning described the first corrective surgery for d-tga (the senning procedure) in 1959, which involved using the atrial septum to create an intratrial baffle that redirected bloodflow at the atrial level; senning yielded a high success rate using this procedure, significantly lowering both early and late mortality rates. due to the technical complexity of the senning procedure, others could not duplicate his success rate; in response, mustard developed a simpler alternative method (the mustard procedure) in 1964, which involved constructing a baffle from autologous pericardium or synthetic material, such as dacron. this procedure yielded early and late mortality rates comparable to the senning procedure; however, a late morbidity rate was eventually discovered in relation to the use of synthetic graft material, which does not grow with the recipient and eventually causes obstruction. in 1966, american surgeons william rashkind and william miller transformed the palliation of d-tga patients with the innovative rashkind balloon atrial septostomy, which, unlike the thoracotomy required by a septectomy, is performed through the minimally invasive surgical technique of cardiac catheterization. the late morbidity rate is high in atrial switch, combined with advances in microvascular surgery, created a renewed interest in mustard's original concept of an arterial switch procedure. the first successful arterial switch was performed on a forty-two-day-old d-tga + vsd infant by jatene in 1975. egyptian cardiac surgeon magdi yacoub was subsequently successful in treating tga with an intact interventricular septum when preceded by pulmonary artery banding and systemic-to-pulmonary shunt palliation. austrian surgeon b. eber was the first to recount a small series of successful arterial switch procedures, and the first large successful series was reported by guatemalan surgeon aldo r. casteneda. in the postoperative period, increased incidence and degree of supravalvular pulmonary stenosis. eliminating the pericardial patch for pulmonary artery reconstruction and using a direct connection reduced the incidence of this complication. by 1991, the arterial switch had become the procedure of choice, and it remains the standard modern procedure for d-tga repair. as long-term results of arterial switch are being reported, newer sets of potential surgical problems are becoming evident. progressive neo-aortic dilation (pulmonary valve at birth) has been observed. however, this dilation does not necessarily translate into aortic regurgitation (ar) and need for surgery in all patients. older age at time of aso, presence of ventricular septal defect, and previous pa banding have been found to be risk factors for ar. supravalvular pulmonary stenosis was commonly observed in the postoperative period. a direct connection of the pulmonary artery reduced the incidence of this complication the world's smallest infant to survive an arterial switch was jerrick de leon, born 13 weeks premature. at the time of the operation on february 6, 2005, he weighed just over 1.5 pounds (700 grams).