“…We routinely adopt a 2-patch technique for repair of cAVSD for all but the shallowest VSDs and have observed a low rate of reoperation for LVOTO. 4 , 5 When reoperation is needed, it is somewhat challenging, often requiring both transaortic and transatrial approaches, and has a high risk of requiring further interventions on the LVOT. 5 Thus, the initial occurrence of LVOTO should be avoided whenever possible, and caution should be used when considering the MSP in patients with a narrow LVOT on preoperative imaging.…”