A 2-year-old boy was diagnosed as having transposition of the great arteries (TGA) and ventricular septal defect (VSD) and underwent pulmonary artery banding. The patient showed slow progression of cyanosis and dyspnea on exertion. Oxygen saturation was 70-75 % and cardiac catheterization showed severe pulmonary hypertension. At the age of 22, the patient underwent a palliative atrial switch operation; oxygen saturation increased to around 95 % and the patient experienced relief of symptoms. Atrial fibrillation and right side pleural effusion occurred but resolved and the patient was discharged.