What question did this study set out to answer?

To investigate the complications arising from low cardiac output syndrome following repair of tetralogy of Fallot in an infant.

January 10, 2026Frontiers in Pediatrics0 citationsOpen Access

Case Report: Low cardiac output syndrome with multisystem complications following total repair of tetralogy of fallot

DSDaendy Nova Setia TTartila YPYogi Esa Prawira

Key Result

A 23-month-old with tetralogy of Fallot developed low cardiac output syndrome post-surgery, leading to junctional ectopic tachycardia and transient cortical blindness, but showed partial visual recove

Key Points

To investigate the complications arising from low cardiac output syndrome following repair of tetralogy of Fallot in an infant.
Case presentation of a 23-month-old male with post-surgical low cardiac output syndrome.
Assessment of complications including junctional ectopic tachycardia and atrial thrombosis.
Interventions included medication and neuroprotective therapies to manage symptoms.
Developed junctional ectopic tachycardia and left atrial thrombus post-surgery.
Showed partial visual recovery by 30 days after discharge from the hospital.
Follow-up echocardiography indicated improved right ventricular function and resolution of arrhythmia.

Structured PICO

Population

23-month-old male with Tetralogy of Fallot (ToF) who underwent complete surgical repair

Intervention

Multidisciplinary management including amiodarone, ivabradine, magnesium, dexmedetomidine, and targeted temperature control for junctional ectopic tachycardia (JET); heparin for left atrial thrombus; and piracetam and mannitol for cortical infarct

Outcome

Clinical course and recovery from multisystem complications (LCOS, JET, atrial thrombosis, cortical blindness)

This case demonstrates that low cardiac output syndrome after Tetralogy of Fallot repair can precipitate a cascade of severe but potentially reversible complications, including cortical blindness, emphasizing the need for comprehensive postoperative surveillance.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background Tetralogy of Fallot (ToF) repair in infants may be complicated by low cardiac output syndrome (LCOS), which can precipitate rare multisystem complications. Junctional ectopic tachycardia (JET), atrial thrombosis, and cortical blindness are underrecognized sequelae requiring multidisciplinary management. Case presentation We report a 23-month-old male with ToF who developed LCOS post-surgery, followed by refractory JET, left atrial thrombus, embolic occipital infarction, and transient cortical blindness. LCOS was defined by elevated lactate, low ScvO₂, hypotension, and oliguria. JET was managed with amiodarone, ivabradine, magnesium, and targeted temperature control. Thrombosis resolved with heparin, yet cortical infarct occurred. Neuroprotective therapy included piracetam and mannitol. Outcome Partial visual recovery was observed by POD-30. Follow-up echocardiography showed improved RV function and resolution of arrhythmia. The patient was discharged on POD-35 with improving neurologic status. Conclusion LCOS can trigger a cascade of cardiac, thrombotic, and neurologic complications. Early recognition and multidisciplinary intervention are essential. This case highlights the potential reversibility of cortical blindness and the importance of comprehensive postoperative surveillance.

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