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Noonan syndrome is an autosomal dominant multisystem disorder characterized by short stature, distinctive facial features, congenital heart defects, and variable developmental delays. While pulmonary valve stenosis is the most common cardiac lesion, Tetralogy of Fallot is rarely reported in Noonan syndrome. To date, there are fewer than 60 documented cases of Noonan syndrome associated with Tetralogy of Fallot in the medical literature. The aim of this book is to report the third documented case of Noonan syndrome from Iraq, uniquely associated with repaired Tetralogy of Fallot. This case underscores the diagnostic importance of reassessing patients with repaired congenital heart disease for underlying syndromic conditions. Increased awareness of Noonan syndrome and its varied cardiac manifestations, including Tetralogy of Fallot, is essential for early diagnosis and comprehensive management, especially in resource-limited settings.