Double outlet right ventricle (DORV) is a complex cyanotic lesion. Both the pulmonary artery and the aorta arise from the right ventricle with a ventricular septal defect emptying the left ventricle. Symptoms and anaesthetic management depend on the position of the ventricular septal defect and any additional lesions and their severity. This is a mixing lesion with a L→R shunt and complications such as reduced pulmonary blood flow with varying degrees of cyanosis, congestive heart failure or pulmonary hypertension.