A Case Report on Anaesthetic Management of Lower Limb Fracture in an Adult with Uncorrected Tetralogy of Fallot

Tetralogy of Fallot is one of the commonest forms of cyanotic congenital heart disease. The treatment strategies currently used in the treatment of ToF result in excellent long-term survival (30-year survival ranges from 68.5% to 90.5%). Unrepaired or nonpalliated, approximately 25% of patients survive to adolescence, after which the mortality is 6.6% per year. Only 3% survive to age 40. Adults with uncorrected ToF pose a challenge for anaethesia because perioperative morbidity and mortality is greater. The most important aspect of the perioperative care is the involvement of a multidisciplinary team with a detailed understanding of the patient’s cardiac defect, their functional status and anticipation of the perioperative stresses. We report a case of middle-aged woman who was asymptomatic during her life and diagnosed with uncorrected ToF during her 32nd year of age now presenting with lower limb fracture after RTA for surgical fixation. The surgery was successfully conducted under graded epidural anaesthesia. This anaethetic technique can be considered as an alternative technique to general anaethesia, in selected patients with uncorrected ToF presenting for lower limb fractures, especially in cases where the risks of administering a general anaethetic are deemed high. Keywords: Congenital heart disease, Right ventricular outflow tract obstruction (RVOTO), Epidural anaesthesia.