all 6 deaths were among the patients with del22q, either related or unrelated to their immunodeficiency. This association was statistically significant [6/15 vs 0/22, difference -0.4, 95% CI -0.65 to -0.15, P ϭ .002].In our experience microdeletion of chromosome 22q11.2 appears associated with poor overall outcome after surgical treatment of PA-VSD with MAPCAs. We believe that such a peculiarity, not necessarily related to special anatomic cardiac features associated with the syndrome itself, should justify the use of a protocol for preoperative assessment of immunologic status of patients with del22q undergoing surgery for PA-VSD with MAPCAs and the administration of a perioperative antifungal prophylaxis when necessitated by a depressed immunologic condition.Within the population of patients with complex congenital heart lesions, the prevalence of genetic syndromes is relevant. 9 Genetic syndromes may influence both clinical outcome and surgical results of treatment of congenital heart defects, both because of peculiar anatomic cardiac features and because of associated extracardiac abnormalities. 9,10 This is the main reason that the possible association with a genetic syndrome should always be included among hypothetic risk factors within the analysis of postoperative outcome of congenital heart defects.