Tetralogy of Fallot (TOF) in adult patients are rare and only few cases have been reported its surgical outcomes. We report a case of 65-year-old female TOF patient with a history of transient loss of consciousness presented with cyanosis and shortness of breath. Her oxygen saturation was 82% in room air. Subsequent investigations revealed remarkable right ventricular hypertension of 99/edp10 mmHg, obstruction to right ventricular outflow with PA pressure of 15/9 (11) mmHg, and underling NYHAIIIchronic heart failure (CHF) with complete A-V block. The patient was preoperatively treated with medications and inserted a percutaneous pacemaker for bradyarythmia. We performed ventricular septal defect closure, pulmonary valve replacement associated with right ventricular outflow tract repair, tricuspid valve repair and pacemaker implantation. Although her recovery from the surgery was uneventful, she revealed symptomatic CHF one and a half years after the surgery. Cardiac catheterization showed significant left ventricular enlargement and diffuse poor wall motion of the heart muscle. We managed the CHF providing with cardiac resynchronization therapy (CRT), which is an adjunctive treatment currently indicated for CHF patients. Left ventricular (LV) hypokinesis with an ejection fraction (EF) of 15.3% on admission improved to normal LV function with an EF of 58.1% 2 years after starting CRT. She remains asymptomatic and has lived without oxygen therapy. In conclusion, concrete surgical repair for TOF in adult patients is recommended. Although the exact origin of the CHF is still unknown, CRT was efficient for managing postoperative cardiac dysfunction.