Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 04 04 1554 1554 EN Sonal Khatavkar Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Priyanka Wadikar Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Mounika Yerramshetty Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2026 01 04 2026 02 02 Mixed-type total anomalous pulmonary venous connection (TAPVC) in a neonate requiring emergency surgical intervention for a strangulated umbilical hernia presents unique anesthetic challenges. We report successful perioperative management of a 24-day-old male infant (3.2 kg) with mixed TAPVC posted for exploratory laparotomy. Key management strategies included careful modulation of pulmonary and systemic vascular resistance, strategic use of inotropic support, and meticulous monitoring of oxygen delivery in the context of right-to-left shunting. The patient remained hemodynamically stable throughout surgery and was successfully managed postoperatively with graduated ventilatory support. This case highlights the critical importance of coordinated anesthetic and surgical planning in neonates with complex congenital heart disease undergoing non-cardiac emergency procedures. https://aacc.tums.ac.ir/index.php/aacc/article/view/1554