Innovative cardiac surgery ('blind' or indirect infundibular resection) for tetralogy of Fallot on a child of 4 years was followed by survival for 43 years without further surgery. The patient 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 valves. Postmortem examination showed severe damage to one of the leaflets of the pulmonary valve, interpreted as due to inadvertent avulsion during the original surgical procedure. A large ventricular septal defect was present, but there was no residual subpulmonary infundibular obstruction.
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