Tetralogy of Fallot (TOF) is a high frequency of cyanotic congenital heart diseases. Recently, most of TOF cases are diagnosed and treated by childhood. The case that adulthood TOF patients of untreated live is very rare. Thus, we report an adult case of untreated TOF discovered after onset of cerebral infarction. A 51-year-old female was diagnosed as ventricular septal defect (VSD) during childhood, but never treated. She developed cerebral infarction a year ago. Recently, she developed a

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... d cerebral infarction and leg edema. Therefore, she was hospitalized for purpose of the diagnosis of Eisenmenger syndrome and the indication for surgical repair. VSD, overriding of the aorta, right ventricular outflow tract stenosis and right ventricular hypertrophy were demonstrated by echocardiography. Right ventricular outflow tract stenosis was severe and peak systolic pressure gradient was 80 mmHg between the right ventricle and the main pulmonary artery. We were suggested that right ventricular pressure load and volume overload. Because we observed D-shape interventricular septum in systole and diastole phase by short-axis view of left sternal border. Contrast-enhanced computed tomography and cardiac catheterization confirmed these findings and she was diagnosed as TOF. We thought cause of cerebral infarction is paradoxical cerebral embolism. We examined exact cause of cerebral infarction, but we couldn't find arteriosclerosis, atrial fibrillation,coagulation disorder and obvious deep venous thrombosis. She underwent successful radical operation and an uncomplicated postoperative course without relapse of cerebral infarction.