The late referral of some patients with congenital cardiac malformations and increased pulmonary blood flow results in an important number of patients with advanced pulmonary vascular disease at the time of diagnosis in Turkey. The decision of denying surgical treatment is a difficult one because the result is near certain death in these patients due to unavailability of donors for transplantation in Turkey. In our hospital 9 patients with pulmonary vascular resistance levels over operable levels were operated on a trial basis starting from January 1994, 5 of these patients were with patent ductus arteriosus and 4 of them were with ventricular septal defects. All of the patients were either infants or children with the oldest patient 9 years in age. All of these patients had pulmonary vascular resistance’s over 6 wood units with hyperventilation and isoproteranol infusion. The highest resistance in the group was 10 wood units. Corrective surgery was performed in all of the patients. Two patients died in the early postoperative period. Seven surviving patients are well and are being followed with diuretic and vasodilator treatment. We have presented this preliminary report to stress the need in defining inoperability criteria in small children in this current era of intensive monitoring, respiratory care and potent vasodilator drugs. While lung biopsy can differentiate absolutely those patients with inoperable pulmonary vascular obstructive disease, it is often difficult to perform and to evaluate. We believe some borderline patients can benefit from surgical correction and this option should be kept in mind especially when the other alternative is certain and early death.