Since surgical correction of congenital heart diseases began in the early 1950s, a growing number of patients are reaching older age and becoming a risk for developing coronary artery disease. This study presents the clinical experience of myocardial revascularization in 4 symptomatic coronary artery disease patients with unrepaired or corrected tetralogy of Fallot. Three patients had surgery and 1 patient had percutaneous angioplasty. One corrected tetralogy of Fallot patient developed symptomatic coronary artery disease and responded favorably to medical therapy.