Surgical management of tetralogy of Fallot (TOF) can be either with a total primary repair or staged repair. The superiority of one technique over the other is still debatable, especially in developing countries with late presentation and limited resources. The objective of this study was to compare the outcome of patients with tetralogy of Fallot and borderline pulmonary anatomy defined as McGoon ratio between 1.2 and 1.6 who underwent primary versus staged repair. Results: The patients were divided into two groups; group A included patients who underwent primary repair (n= 120), and group B included patients who underwent repair after previous modified Blalock-Taussig (MBT) shunt operation (n = 100). Patients in group B were significantly older (11 ± 2.6 vs. 7 ± 3.1 months; p