{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T06:48:02Z","timestamp":1767682082190,"version":"3.48.0"},"reference-count":7,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>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 ScvO\u2082, 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2025.1681837","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T06:44:29Z","timestamp":1767681869000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Low cardiac output syndrome with multisystem complications following total repair of tetralogy of fallot"],"prefix":"10.3389","volume":"13","author":[{"given":"Daendy","family":"Nova Setia","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Tartila","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yogi","family":"Prawira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"B1","first-page":"33","article-title":"Incidence and risk factors for early postoperative arrhythmias in children with congenital heart disease: a systematic review","volume":"9","author":"Mayaya","year":"2025","journal-title":"J Clin Electrophysiol"},{"key":"B2","first-page":"e406","article-title":"Management of junctional ectopic tachycardia after congenital heart surgery","volume":"22","author":"Joye","year":"2021","journal-title":"Pediatr Crit Care Med"},{"key":"B3","first-page":"2724","article-title":"Dexmedetomidine in the management of postoperative junctional ectopic tachycardia","volume":"34","author":"Ishaque","year":"2020","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"B4","first-page":"1617","article-title":"Thromboembolic events following repair of tetralogy of fallot: incidence and predictors","volume":"124","author":"Egbe","year":"2019","journal-title":"Am J Cardiol"},{"key":"B5","first-page":"403","article-title":"Thrombosis in pediatric congenital heart disease: risk factors, mechanisms, and prevention","volume":"16","author":"Abdelghani","year":"2020","journal-title":"Heart Fail Clin"},{"key":"B6","first-page":"1491","article-title":"Cortical blindness after pediatric cardiac surgery: a case report and literature review","volume":"33","author":"Lee","year":"2017","journal-title":"Child Nerv Syst"},{"key":"B7","first-page":"27","article-title":"Piracetam for neurologic recovery in pediatric ischemic stroke: case series and mechanistic insights","volume":"80","author":"Bhatt","year":"2018","journal-title":"Pediatr Neurol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1681837\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T06:44:40Z","timestamp":1767681880000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1681837\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,6]]},"references-count":7,"alternative-id":["10.3389\/fped.2025.1681837"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1681837","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,6]]},"article-number":"1681837"}}