It is 130 years since Fallot described the 4 cardinal features of la maladie bleue [1] namely the complex of pulmonary infundibular stenosis, an interventricular communication, biventricular connection of the aorta and right ventricular hypertrophy. Our understanding of the developmental anomaly, phenotypic features and surgical management has advanced considerably in the intervening years [2–4]. The anterocephalad deviation of the outlet septum, with associated abnormal septoparietal trabeculations, is now accepted as the hallmark of tetralogy [5, 6]. This outlet septal deviation also results in varying degrees of aortic override and can be associated with several types of ventricular septal defect [7].