Tetralogy of Fallot is one of the most common cyanotic congenital cardiac disease concerning 10% newborn with congenital heart failures. About 3% of those patients have anomalous left anterior descending coronary artery. We report a case of 21 – year – old patient with tetralogy of Fallot and with coronary artery abnormality after staged cardiac surgeries. Due to an anomalous coronary artery, crossing the right ventricule outflow tract, the patient needed to conduit type of repair. JRCD 2014; 1 (8): 19–26