The hybrid approach to the therapy of congenital heart disease consists of the combination of surgical and interventional techniques in order to improve safety and to achieve better results. Here we report on a new application of this concept: the use of cutting-balloon angioplasty in a hybrid setting. After failure of conventional angioplasty by using high-pressure balloons, a 2-year-old girl with a diagnosis of tetralogy of Fallot with pulmonary atresia and hypoplasia of the pulmonary arteries underwent cutting-balloon angioplasty of a tight stenosis of the left pulmonary artery in the operating room. The procedure allowed the salvage of the left pulmonary artery and the result was stable during follow up.