Tetralogy of Fallot (TOF) is a disease consisting of malalignment of the outlet septum-ventricular septal defect (VSD), aortic override, pulmonary outflow tract stenosis and right ventricular hypertrophy. It is common in pediatric congenital heart disease but rare in un-operated adult especially those older than 50 years of age. We report a male patient with TOF diagnosed at age 56 and successfully operated. This patient was the oldest documented publicly in Taiwan undergoing successful corrective surgery for TOF.