Total Correction of Tetralogy of Fallot with Large ASD in a Child with Laryngomalacia and Microcephaly: A Case Report

Abstract

Tetralogy of Fallot (TOF) is becoming the most common cyanotic congenital heart disease, so there are many considerations for anesthesia and perioperative management, and also comorbidities such as laryngomalacia and microcephaly make its management quite challenging. This case report describes the perioperative and intensive care management of a patient undergoing total correction of TOF with a large ASD, complicated by postoperative atelectasis, pneumonia, and ventricular tachyarrhythmia. A 1-year-11-month-old boy with a weight of 10.2 kg was diagnosed with TOF + large secundum ASD, with a history of cyanotic spells, malnutrition, and laryngomalacia. Baseline SpO₂ was 85% on room air, and echocardiography shows severe infundibular pulmonary stenosis (PG 94 mmHg). The patient underwent total correction, including pulmonary valve-sparing infundibulectomy, patch closure of VSD and ASD, and tricuspid commissuroplasty, with intraoperative TEE monitoring. He developed ventricular tachycardia after cross-clamp removal, successfully treated with DC shock and amiodarone infusion. Postoperatively, he required prolonged mechanical ventilation and reintubation due to atelectasis and nosocomial pneumonia. This case highlights the importance of meticulous hemodynamic and airway management in TOF with comorbidities. Multidisciplinary care, intraoperative TEE guidance, and early recognition of postoperative complications contributed to a favorable outcome.