Cardiac resynchronization therapy is a common option in adult patients with heart failure and conduction abnormalities. Specific selection criteria for pediatric population are lacking. We report the case of a 14-year-old boy with signifi cant pulmonary regurgitation subsequent to corrected tetralogy of Fallot and single chamber permanent pacing which presented with heart failure symptoms. Careful management was planned by a Heart Team including pediatric cardiologist, cardiac surgeon, interventional cardiologist and anesthesiologist. After undergoing cardiac surgery with complete correction of the pulmonary regurgitation and upgrade to a triple chamber pacing, the patient was discharged in good clinical status.