**5.3 Late presentation and diagnosis**

Interestingly, if there are no additional associated defects ccTGA may go unnoticed until adolescence or adulthood. Case reports have even cited incidental findings and late diagnoses of ccTGA in adults in the fifth to eighth decades of life (Chang et al., 2009; Jennings et al., 1984; Orchard et al., 2010; Scardi et al., 1999). A cohort of patients with ccTGA over 18 years of age who presented to an adult CHD clinic over a 15 year period is described by Beauchesne et al (2002). Sixty-six percent of these patients were over 18 years of age when diagnosed, and 17% of the cohort was over 60 years old at the time of diagnosis. Common reasons for referral in such patients range from abnormal ECGs and cardiomegaly on chest radiographs to complete heart block and murmurs (Presberito et al., 1995).
