The relationship between double-outlet right ventricle and tetralogy of Fallot has long been contentious, largely centred on the dogma that bilateral infundibulums are needed to make the diagnosis of double outlet. Other disagreements have been related to the required degree of aortic overriding, with authors recommending from more than 50% to approximately 85–90% [7, 21, 22]. Double outlet, nonetheless, is a type of ventriculo-arterial connection rather than a distinct anomaly and can be found in the setting of tetralogy [23]. In the initial description provided by Fallot himself [1], one of the hearts was described as having the aortic root exclusively supported by the right ventricle. The aortic override found in our hearts varied from 31% to 100%, including 6 hearts with the aortic root supported exclusively by the right ventricle and hence having unequivocal double-outlet ventriculo-arterial connection. This has implications for surgical repair, since in these circumstances a much larger patch will be required to baffle blood from the left ventricle and through the interventricular communication to the aortic root [24]. It follows that the area usually described as the ‘ventricular septal defect’ in the double-outlet right ventricle is never closed. It is the area patched to connect the aortic root with the left ventricle that is analogous to the ventricular septal defect as described in the setting of tetralogy of Fallot with concordant ventriculo-arterial connections.