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We report our experience caring for a 5-year-old male with unrepaired ToF from a low-resourced country presenting with a hematocrit of 76.2%, requiring unique perioperative considerations. This work aligns with the unifying mission among congenital heart providers to improve access to high-quality surgery globally through collaboration.<\/jats:p>","DOI":"10.1177\/21501351261472481","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T14:02:26Z","timestamp":1792591346000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative Challenges of Unrepaired Tetralogy of Fallot in a Child With Severe Secondary Erythrocytosis: Lessons for the Modern Era"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3495-6639","authenticated-orcid":false,"given":"Ruchika","family":"Kamojjala","sequence":"first","affiliation":[{"name":"Case Western Reserve University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel M.","family":"Hoenig","sequence":"additional","affiliation":[{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukman A.","family":"Faniyi","sequence":"additional","affiliation":[{"name":"Akron Children's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8356-0434","authenticated-orcid":false,"given":"Sahithi","family":"Bhavana","sequence":"additional","affiliation":[{"name":"Akron Children's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvette","family":"Zhu","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Stumh","sequence":"additional","affiliation":[{"name":"Akron Children's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Clark","sequence":"additional","affiliation":[{"name":"Akron Children's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Akron Children's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Karamlou","sequence":"additional","affiliation":[{"name":"Akron Children's Hospital"},{"name":"Department of Pediatric Cardiothoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"133","volume-title":"Commonwealth Fund Publications, 131","author":"Taussig HB.","year":"1960","unstructured":"Taussig HB. Congenital malformations of the heart: specific malformations. In: Commonwealth Fund Publications, 131. 2nd ed. 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