OBJECTIVE: We report a case of anesthetic management of 34 yr female 6th gravida, 39 weeks pregnancy with uncorrected Tetralogy of fallot for elective LSCS.

METHOD: TOF is the most common cyanotic congenital heart disease causing intra-cardiac R-L(right to left) shunt and characterized by VSD, aortic overriding, pulmonary artery outflow obstruction and RVH. We were reporting a case of 34 yrs female 6th of age not underwent any surgical correction. She has breathlessness on exertion but otherwise adjusted to normal life. Her O2 saturation was 82% on room air. The important echo finding was large subaortic VSD with bidirectional shunt(80% override). She was given general anaesthesia considering the technique which prevents further increase in R-L shunt.

RESULTS: Patient was successfully extubated without any significant complication. She delivered a female child of 1.8 kg with IUGR but APGAR 9/10.

CONCLUSION: Proper understanding of the anatomical defect and direction of the flow is important for the management of TOF patient. Cutting short second stage with planned LSCS and considering the factors affecting R-L shunt which anaesthetizing patients are important for positive outcome. gravida, 39 week pregnancy known case of TOF diagnosed at 5 yr