AbstractBetween October 1987 and November 1992, 165 consecutive patients underwent isolated transpulmonary repair for tetralogy of Fallot. Their ages ranged from 1 to 44 years and their weight ranged from 6 to 61 kg (mean 19.4). Of these 165 patients, 65% required annulus enlargement. The postrepair peak right ventricular/left ventricular pressure was 0.2 to 0.84 (mean 0.51). There were nine early deaths (5.5%) and one late death. All survivors have been followed up. Echocardiography revealed minimal to mild pulmonary regurgitation in those patients who had annulus enlargement. There were three patients who had gradient across the outflow tract of more than 40 mmHg. One of these required reoperation. We believe that all tetralogy of Fallot can be repaired through the pulmonary artery. Since we have used this approach for only 5 years, we are unable to compare the long‐term results with those of other approache