A 14-year-old girl underwent primary total correction of tetralogy of Fallot (TOF). Acute intraoperative postperfusion right ventricular failure was encountered and all trials to wean the patient off cardiopulmonary bypass failed in spite of adequate pharmacological support. Survival was achieved, however, when an atrial septal defect was created and right ventricular decompression was thus established with a consequent increase of left atrial and left ventricular pressures and cardiac output.
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