Tetralogy of Fallot is the most common form of cyanotic congenital heart disease. Survival after the age of 12 years without corrective surgery is rare. We present the case of a 25 year-old man with uncorrected tetralogy of Fallot. Possible reasons for the longetivity in this patient are left ventricular hypertrophy and systemic to pulmonary shunting through internal mammary arteries.