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This chapter provides an overview of the congenital cardiac condition known as d-transposition of the great arteries and its most modern form of repair, the arterial switch operation. Using a case-based format, the chapter aims to describe the neonatal physiology prior to repair, the surgery itself, and what anesthetic and other healthcare providers can expect as major postoperative sequelae long term. The chapter discusses how these salient details can affect pre-, intra-, and postoperative management of these patients undergoing noncardiac surgery.