A classical echo of a common AV canal .
Note the free floating common AV leaflet
With all chambers interconnected it is a free for all circulation . The blood seems to get mixed at the level of common AV orifice . Even though one expects severe cyanosis in common AV canal , the intensity of which is primarily determined
the net blood flow to lungs which is dictated by the pulmonary vascular resistance or the RVOT obstruction. This patient had no RVOT obstruction but had severe pulmonary arterial hypertension. In spite of raised PVR , some amount of volume over load of lungs occur.
How to assess the operability ?