Case report on anaesthetic management of Tetralogy of Fallot (TOF) in an adult patient.

Background and objectives: TOF is the most common type of congenital cyanotic heart disease accounting for 3.5% of all cases. TOF consists of a single large VSD, overriding of aorta, right ventricular outflow tract obstruction and right ventricular hypertrophy. But adult patients with non-corrected TOF are rare because 50% of children cannot make it to adulthood without surgery.

Case report: a male patient aged 27 years with TOF was admitted for its correction. His examination showed peripheral cyanosis, clubbing, pansystolic murmur and a haemoglobin of 18.4 g/dl. General anaesthesia consisted of propofol (backed up with phenylephrine),fentanyl, midazolam, pancuronium, vecuronium and sevoflurane. A trans-right atrial approach of VSD closure using pericardial patch with resection of the right ventricular outflow tract done. Milrinone and dopamine used for haemodynamic stability. Patient shifted to ICU where he stayed for 3 days and on the 10th postoperative day was discharged from hospital in good health.

Conclusion: This case illustrates the successful management of a high risk, adult TOF by the combined team of anesthetists, surgeons and intensive care.