A 35-year-old man with residual Waterston shunt and concomitant right pulmonary artery stenosis after mutiple surgery for tetralogy of Fallot presented with significant left to right shunt and left heart failure. We describe the percutaneous placement of an endovascular stent graft to occlude the Waterston shunt and relieve the right pulmonary artery stenosis simultaneously. This novel use of a covered stent effectively treated a residual problem without reoperative thoracotomy. © 2005 by The Society of Thoracic Surgeons.