The management of patients with congenital heart defects, associated with atrioventricular discordance continues to remain a challenge for paediatric cardiac surgeons and cardiologists. The paper by Acar and colleagues in this issue1 is a timely review of their institution’s management programmes for this condition, and highlights the role of the tricuspid valve in determining the outcome in this group of patients. They note in their paper, as have others,2-4 the relatively high morbidity and mortality associated with the classic repair of congenitally corrected transposition, when the right ventricle remains in the systemic circulation. Hence, the move to consider other approaches, in particular, the double switch repair where the left ventricle is relocated to the systemic circulation.

Acar et al had a study population of 62 patients from a total population of 141, and in analysing this group of patients they note that the prevalence of tricuspid regurgitation in the preoperative group was significantly higher in patients who had an associated ventricular septal defect (91%). However, tricuspid regurgitation was also common in patients with an intact ventricular septum (38%), and those with a ventricular septal defect and some form of pulmonary obstruction (36%). The surgical mortality for conventional surgery, where the right ventricle remains in the systemic circulation, was five of …