HISTORY:  ,The patient is a 5-1/2-year-old with Down syndrome, complex heart disease consisting of atrioventricular septal defect and tetralogy of Fallot with pulmonary atresia, discontinuous pulmonary arteries and bilateral superior vena cava with a left cava draining to the coronary sinus and a right aortic arch. 
HISTORY : , The patient is a 5 - 1/2 - year - old with Down syndrome , complex heart disease consisting of atrioventricular septal defect and tetralogy of Fallot with pulmonary atresia , discontinuous pulmonary arteries and bilateral superior vena cava with a left cava draining to the coronary sinus and a right aortic arch .