Innovative cardiac surgery (‘blind’ or indirect infundibular resecion) for tetralogy of Fallot on a child of 4 years was followse by survial for 43 years without further surgery. The patinent remained well until about one year before death, when he developed clinical features of progressive biventricular failure associated with pulmonary hypertension and incompetence of the pulmonary and tricuspid value. Postmortem examination showed severe damage to one of the leaflets of the pulmonary valve, interpreted as due to indavertent avulsion during the original surgical procedure. A large ventricular septal defect was present but there was no residual subpulmonary infundibula obstruction
