Though it has been mentioned that a couple of small right ventricular branches also arise from the LAD supplying small parts of the anterior right ventricle (1) but no such surgical image has been published in literature in the past.

We present a case of Tetralogy of Fallot accompanied by a type II Aorto-Pulmonary Window with severe pulmonary arterial hypertension in a pediatric patient. A successful repair of TOF with trans-pulmonary patch closure of APW was done.