[A 63-year-old man with uncorrected tetralogy of Fallot]

An exceptional case of tetralogy of Fallot is reported; the patient survived without severe symptoms or surgical treatment. The diagnosis was made by echocardiography at the age of 61 years when the patient experienced hypertensive retinopathy. Death occurred at 63 from myocardial infarction. It is thought that longstanding hypertension had contributed to a diminished right-to-left shunting, thus reducing cyanosis and hypoxic damage to the myocardium, which enabled prolonged survival.