Abstract Background: This disease of heart is named after Fallot who correlated the pathologic and clinical manifestations of this cardiac malformation in his description of L'anatomie pathologique de la maladie bleu by 1888. He was the first to appreciate the complex of this cardiac malformation which he coined a “Tetralogy" consisting of pulmonary stenosis, Ventricular Septal Defect (VSD), dextroposition of the aorta, and RV hypertrophy. Aim of Study: To collect, review and analyze the data of Fallot patient undergoing total repair and to compare the early outcome of Fallot repair with preservation of the annulus versus transannular patch. Patients and Methods: This is a retrospective analysis which conducted at the Cardiothoracic Surgery at Ain Shams University Hospital from the first of January 2014 till the end of December 2016. Results: The majority of patients with TOF have a bicuspid or tricuspid PV, which is the most favorable surgical anatomy for preserving the PV, independent of the presence or degree of leaflet dysplasia. We believe that the preservation of the PV annulus and PV function during early repair of TOF, by combining intraoperative PV dilation and additional surgical procedures, can be extended to the majority of patients with classic TOF. The recent introduction of more-complex PV plasty techniques allowed us to further extend the applicability of PV-preservation techniques. Conclusion: The optimal repair technique would be there-fore, dictated to the anatomical substrate of the lesion, the patient's age, prevailing surgical practice and other patient preoperative characteristics which all should be taken into relevance in an effort to improve patient outcomes.