AbstractA 54‐year‐old housewife with pulmonary atresia and ventricular septal defect developed increasing cyanosis, dyspnea, weakness, and myocardial ischemia. Initial cardiac catheterizations with angiography, including subtraction techniques, did not definitely indicate main pulmonary artery or right or left pulmonary arteries that would make her amenable to currently available surgical correction. Single‐crystal suprasternal notch echocardiography indicated the presence of a small but definite right pulmonary artery. She subsequently underwent first‐stage surgical correction after angiography and selective catheterization of aortopulmonary shunt vessels, which also revealed the presence of small proximal pulmonary arteries.