A 12-yr-old patient was admitted due to severe hemoptysis and known cyanotic CHD. In chest P-A and echocardiogram, pulmonary aspergilloma in left upper lobe was associated with TOF. The cardiac catheterization couldnt be done because of frequent hypoxic spell and severe hemoptysis. Surgical management was performed. After left posterolateral thoractomy, modified Blalock-Taussig shunt operation and left upper lobe lobectomy were done at same time. Postoperative PaO2 was elevated and hemoptysis was disappeared.