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We thank Dr Sainathan for his eComment on our article [1, 2]. The author suggests an alternative strategy of placing bilateral branch pulmonary artery bands while leaving the aortopulmonary (AP) window intact as was used by Hosein et al. [3] for the management of patients with hypoplastic left heart syndrome (HLHS). While there may be different ways of managing rare complex anatomies such as tricuspid atresia and aortopulmonary window, in addition to the surgical strategy, we once again would like to highlight the interesting physiology in this patient, which we believe is related to ventricular volume unloading following AP window ligation leading to restriction at the level of the ventricular septal defect.  We have successfully used bilateral branch pulmonary artery bands as a bridge to decision in high-risk patients with HLHS [4]. While this approach is to be recommended in certain selected patients, it is not a procedure free of problems, as Hosein et al. themselves in their report have accepted as ‘fundamentally flawed’ [2].  Conflict of interest: none declared

eReply. Re: Balancing the pulmonary circulation in tricuspid atresia with an aortopulmonary window