Children with complete atrioventricular canal often require operation in the first year of life. The principal indication for early operation is congestive heart failure intractable by conservative means. In the past, it was the authors' policy to treat such infants with pulmonary artery banding, but the operative mortality was high (28%). Since January 1975 a policy of early total repair for severely symptomatic infants has been adopted. Repair of complete atrioventricular canal was carried out in 21 patients between December 1971 and August 1977. Ages at operation ranged from 2 mth to 14 yr. Eight had 1 or more additional cardiac lesions. Nine patients had undergone previous pulmonary artery banding. The operative technique followed that which was described by Rastelli and his colleagues, though 1 minor modification i.e. the incorporation of the coronary sinus into the left atrium, was used in a number of patients. This maneuver avoids the area of the atrioventricular node and bundle of His. His bundle mapping was not used in this series. The overall hospital mortality was 33% (7 out of 21), it was not increased by previous pulmonary artery banding (3 out of 9 as compared with 4 out of 12 without pulmonary artery banding). Six patients were younger than 1 yr, 1 of whom - a 2-mth-old baby - died. The overall survival rate is improving. During the period 1971 to 1974, 8 patients were operated upon with 5 deaths (63%), but since 1975 only 2 out of 13 operated have died (15%). There have been no late deaths.