Abnormalities in the expression and distribution of Connexin 43 (Cx43) in cardiomyocytes may lead to anomalous conotruncal embryogenesis and disturbances in the maturation and function of the heart. Tetralogy of Fallot (TOF) is the most frequent, cyanotic congenital heart defect in which conotruncal anomalies, right ventricle dysfunction and life-threatening arrhythmias occur. In this study, age-related changes in the expression and spatial distribution of Cx43 in cardiomyocytes from TOF children compared to patients without right ventricular outflow tract pathology were determined Confocal microscopy and flow cytometry were used to assess the changes. Disturbances in both the expression and distribution of Cx43 were found. In the group of infants with TOF, a lower level of expression of the protein was determined. Cardiomyocytes from TOF hearts were found to have Cx43 distributed over their entire surface, which is the pattern seen in immature tissue. In the controls, Cx43 was located within the intercalated disks. Expression of Cx43 in TOF hearts increases with the age of the subject, whereas its spatial distribution remains the same in both infants and older children. Disturbances in Cx43 expression and localization may influence heart embryogenesis and maturation, contribute to hypertrophy and dysfunction of the right ventricle and induce arrhythmias in children with TOF. Early redistribution of Cx43 and functional maturation of the heart muscle support a strategy of early total correction of the defect.