Anesthetic Management Challenges in a Patient with Uncorrected Tetralogy Fallot (TOF) and Cerebral Abscess

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, characterized by overriding aorta, right ventricular hypertrophy, pulmonary stenosis, and ventricular septal defect. Cerebral abscess is frequently found in ۲۵-۴۶% of patients with cyanotic heart disease. We reported a case of cerebral abscess in a ۱۲-year-old female patient with a history of TOF. The patient had clubbing fingers and looked cyanosis with an oxygen saturation of ۷۸-۸۰% with free air. Chest X-ray examination presented a boot shape. Head CT scan presented an abscess in the subcortical right frontal and temporal lobe. The patient was then assessed PS ASA category three because an intracranial process was found with TOF comorbidity. The patient needed a VP shunt. However, perioperative management of pediatric patients with intracranial infections and cardiovascular physiology changes due to congenital heart disease was a challenge in itself and carried a high risk of morbidity and mortality. The anesthetic problem in this patient was the risk of hemodynamic disturbances due to chronic hypoxemia, secondary polycythemia, and the presence of RL shunt. Cyanotic spells often occur during surgery due to decreased systemic vascular resistance (SVR) and cardiac muscle spasms. This case report aims to provide an overview of anesthetic management in case of cerebral abscess in patients with TOF.

Keywords:

anesthetic management , cerebral abscess , Congenital heart disease , TETRALOGY OF FALLOT