Over the last two decades, numerous conduit options and implantation techniques have been described for right ventricular outflow tract (RVOT) reconstruction in the management of tetralogy of Fallot (TOF) with hypoplastic pulmonary annulus. The limited availability of homografts and the cost factor have led us to explore the use of decellularized xenografts as an alternative. Here we present a nine-year follow-up of an adult patient with TOF with hypoplastic pulmonary annulus, who underwent reconstruction of the RVOT by the double-barrel technique, using a decellularized porcine pulmonary artery xenograft valved conduit.