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

## TL;DR

A child with repaired Tetralogy of Fallot developed low cardiac output syndrome, leading to rare complications requiring multidisciplinary care.

## Contribution

This case report highlights the underrecognized multisystem complications of low cardiac output syndrome following ToF repair.

## Key findings

- LCOS can lead to junctional ectopic tachycardia, atrial thrombosis, and cortical blindness.
- Multidisciplinary management including neuroprotective therapy led to partial recovery of vision.
- Early recognition and treatment improved cardiac and neurological outcomes.

## Abstract

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.

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.

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.

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.