Early Continuous Renal Replacement Therapy in Severe Right Ventricular Dysfunction After Total Repair of Tetralogy of Fallot: A Paediatric Case Report

Postoperative right ventricular (RV) dysfunction remains a major cause of morbidity in paediatric patients undergoing total correction of Tetralogy of Fallot (TOF). Fluid overload, systemic inflam-matory response, and ventricular interdependence may further aggravate RV failure in the early postoperative period. Continuous renal replacement therapy (CRRT) has traditionally been used for renal indications; however, its role as an adjunctive strategy for RV unloading in paediatric cardiac surgery remains underreported.
We report a paediatric patient with TOF who underwent total surgical correction and developed postoperative complications, including residual ventricular septal defect (VSD), severe tricuspid regurgitation (TR), hepatic vein systolic reversal, and restrictive RV physiology. Early CRRT helped stabilize the fluid balance, improve hemodynamic parameters, and was key to improving postoperative outcomes.
CRRT may be considered as an adjunctive, non-renal therapeutic strategy for managing fluid over-load, acid-base disturbances, and right ventricular dysfunction in critically ill paediatric patients after cardiac surgery.