Thirty-six patients (7.6%) underwent reoperation after total correction of tetralogy of Fallot in our institution from 1955 to 1997. Eight patients underwent a second reoperation in the same follow-up period. The indications for surgical repair were recurrent or residual lesions alone (Qp/Qs > or = 2.0, right ventricule-pulmonary artery pressure gradient > or = 50 mmHg, tricuspid regurgitation: (TR) > or = grade 3, pulmonary regurgitation (PR) > or grade 3), or in combination with other lesions. The reoperation consisted of closure of a residual VSD in 12 patients (33.3%), relief of right ventricular outflow obstruction in 12 (33.3%), tricuspid valve repair or replacement for TR in 11 (30.6%), and pulmonary valve repair or replacement for PR in 10 (27.8%). The indications for second reoperation consisted of mainly residual or recurrent TR or infections endocarditis. There was one operative death (2.8%) in the reoperation group and one death (12.5%) in the second reoperation group. Five patients (14.7%) died during a follow-up period of 1-25 years (mean 11.6 years). Twenty-none patients (80.6 %) survived surgery, and 25 (86.2%) are now in NYHA class I and 4 in class II. Reoperation and second reoperation are associated with a low mortality rate and good long-term results in our surgical experience.