ABSTRACT
We present a 70-year-old woman who underwent a classic Blalock-Taussig shunt for tetralogy of Fallot (TOF), followed by intra-cardiac repair at the age of 25 years. She developed heart failure due to aortic regurgitation with aortic root dilatation and pulmonary regurgitation 45 years after the surgery. She was successfully treated with concomitant biventricular outflow tract reconstruction (aortic valve, ascending aorta, and pulmonary valve replacement). The treatment strategy for aortic regurgitation with aortic root dilatation after TOF repair is unclear. With a transient increase in the number of elderly patients who have undergone the classic Blalock-Taussig shunt as palliative surgery, the number of complex cases of both right and left ventricular outlet tract involvement will also increase. With patients' advanced age and situation of complex reoperation taken into consideration, aortic valve and ascending aorta replacement may be useful options for cases of aortic regurgitation and aortic root dilatation.