Perioperative management of uncorrected tetralogy of Fallot presenting for emergent noncardiac surgery: A case report

With only about 3% of patients with uncorrected tetralogy of Fallot surviving past age 40, we describe the case of an uncorrected tetralogy of Fallot following a palliative, now obstructed, Blalock-Taussig shunt in a man who presented for emergent noncardiac surgery. Due to limited in-house records, managing this complex patient presentation required obtaining outside-hospital records, performing point-of-care diagnostic studies, and coordinating with the surgical team. We employed monitored anesthesia care with the option to convert to general anesthesia if needed. The patient was discharged after a 3-day intensive care unit stay and cleared for normal activity at his 3-week follow-up. This case highlights the importance of interdisciplinary collaboration, knowledge of prior surgical history, and understanding intraoperative hemodynamic goals for successful planning and perioperative management.