Primigravida with trilogy of Fallot (severe pulmonary stenosis, right ventricular hypertrophy and huge atrial septal defect) for emergency lower segment caesarean section

Trilogy of Fallot; a triad of pulmonary stenosis, right ventricular hypertrophy and atrial septal defect is an uncommon acyanotic congenital heart disease. We present a severe case of trilogy of Fallot diagnosed for the first time in pregnancy. The patient was otherwise in a compensated state and had become symptomatic due to physiological changes in pregnancy. The anaesthetic goals therefore included maintaining the existing physiology and preventing decompensation thereby avoiding Eisenmengerisation. The anaesthetic management of the severe and complex heart disease keeping patient safety at the core is discussed. Keywords: Caesarean section, congenital heart disease, trilogy of Fallot.