Potts anastomosis is a central systemic-pulmonary surgical shunt between the descending aorta and the left pulmonary artery, developed and subsequently disbanded in the 1950s to provide pulmonary blood flow in patients with tetralogy of Fallot. Blalock-Taussig shunt is a peripheral systemic pulmonary communication which was varied to make the modified Blalock-Taussig shunt, which is now the standard of surgical care for temporary or permanent blood flow to the right or left pulmonary artery from the subclavian artery. The central shunts were disbanded in the 1950s as early development of pulmonary hypertension and its sequelae were the major prohibitive complications. This is a case report of a patient with tetralogy of Fallot with a rare combination of doubly committed sub-arterial ventricular septal defect, anomalous left anterior descending coronary artery crossing the right ventricular outflow tract and patent ductus arteriosus, who developed pulmonary hypertension within four years of Potts anastomosis and then required cardiac and lung transplantation. The transthoracic echocardiographic images are the focussed feature in this paper, confirming clearly defined structural anatomy in complex structural congenital heart disease.