Tetralogy of Fallot’s is a cyanotic heart disease with a ventricular septal defect, an overriding aorta, right ventricular outflow tract obstruction and a resulting right ventricular hypertrophy. The lesion is a combination of obstruction and a R→L shunt at ventricular level. Anaesthetic management of this lesion is to maintain preload, decrease pulmonary vascular resistance with oxygen and mild hyperventilation to improve forward flow through the right ventricular outflow tract obstruction and to avoid tachycardia. Inotropes might be needed for impaired function.