For the fourth surgical-educational mission to Rostov-on-Don, Heart to Heart coordinated its first ever team co-led by an advanced Russian pediatric cardiac surgical team combined with American pediatric cardiac specialists. Heart to Heart was grateful to work again with three of its long-time colleagues from the Tomsk Cardiac Center. Nationally recognized pediatric cardiac surgeon, Dr. Evgeny Krivoshchekov, has earned an excellent track record in the surgical treatment of congenital heart defects on patients of all ages at his home center in Tomsk. This year in Rostov-on-Don, he helped lead the Heart to Heart team in performing a series of Tetralogy of Fallot operations of various complexities. The patients ranged from 10 months to 29 years of age. Dr. K's surgical team includes two of Heart to Heart’s close colleagues from his home institution. Dr. Vladimir Ginko operated the heart-lung machine and taught advanced perfusion techniques to local doctors. Dr. Ginko served as Heart to Heart's perfusionist before, on their first trip to Rostov-on-Don (Fall 2009) working on Dr. Bert Litwin's OR team. Dr. Alexander Nikolishin, chief ICU doctor and anesthesiologist from Tomsk, observed Heart to Heart's work in Rostov-on-Don last year. This year as part of the Heart to Heart team, Dr. Nikolishin focused on anesthesia in the OR, including modeling reporting procedures from OR to ICU staff post-operatively. The "mixed" Heart to Heart team worked together to role model best practices as they combined their efforts to operate on 5 patients with life-threatening heart defects in Rostov-on-Don.