This tutorial will review Tetralogy of Fallot, from its first description to current surgical techniques. The role of advanced imaging in diagnosis and patient management will be included, with focus on two-dimensional transthoracic echocardiography. Neonatal and adult examples will be presented, including the patient with unoperated Tetralogy of Fallot and the surveillance and follow up of patients following surgery. Finally, imaging and decision making in coordination of care with pulmonary valve replacement in follow-up of patients with Tetralogy of Fallot will be addressed. Lastly, we will discuss the role of imaging in the controversial topic of timing of pulmonary valve replacement during late follow-up in Tetralogy of Fallot.