From April 1984 to April 1987, surgical anatomic correction was performed in 86 newborn infants, 2-23 days old (6.8 +/- 3.6 days, mean +/- SD) with simple transposition of the great arteries. In all patients, the pulmonary artery was reconstructed by end-to-end anastomosis according to the Lecompte maneuver, including eight patients with side-by-side position of the great arteries. Three different approaches were used. In the first 10 patients (group 1, six survivors), two separate patches of preserved tanned pericardium were used to reconstruct the pulmonary artery, whereas in the next 15 patients (group 2, 13 survivors), a single patch of the same material was used, and in the last 61 patients (group 3, 56 survivors), surgery was performed with a single patch of fresh autologous pericardium. Among the 75 survivors, 68 (including six in group 1, 12 in group 2, and 50 in group 3) were followed serially for at least 6 months (6-48 months, 26 +/- 9 months) with sequential noninvasive evaluations. At follow-up, all were asymptomatic with normal growth. Two patients with severe pulmonary artery stenosis (group 1) were successfully reoperated on. Four infants with moderate pulmonary artery stenosis have been followed medically and have had stable right ventricular pressures. The last 62 patients have normal or near-normal right ventricular pressures. The spatial relation of the great arteries did not affect the quality of the results. Group 1 had clearly the worst results.(ABSTRACT TRUNCATED AT 250 WORDS)