Pentalogy of Fallot is a rare cyanotic congenital heart disease characterized by 
biventricular origin of the aorta above a large ventricular septal defect, 
obstruction of the pulmonary outflow, right ventricular hypertrophy (tetralogy 
of Fallot), and an atrial septal defect. Mortality due to syncope, arrhythmia or 
congestive heart failure is about 75% by the age of 10 years and 97% by the age 
of 40. We report a 69-year old female with uncorrected pentalogy of Fallot who 
suffered from recurrent syncope during classic cyanotic spells. Treatment with 
bisoprolol is recommended in symptomatic children and also improved symptoms in 
our patient. We conclude that single patients with pentalogy of Fallot reach the 
seventh decade and that cyanotic congenital heart disease is a rare cause of 
syncope in the elderly.