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Objective Tetralogy of Fallot (TOF) usually presents with a large non-restrictive ventricular septal defect (VSD).  Case(s) We hereby report a rare case of prenatal diagnosis of TOF with a restrictive VSD secondary to redundant tricuspid valve tissue. Partial occlusion of the VSD resulted in prenatal progression to myocardial hypertrophy and postnatally to right heart failure with difficult management.  Conclusion Prenatal signs of cardiac dysfunction in TOF should prompt a detailed exam of the VSD. Parents and neonatologists must be advised and delivery must be guaranteed in a tertiary center.

Prenatal diagnosis of tetralogy of Fallot with a restrictive ventricular septal defect