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Tetralogy of Fallot (ToF) is the most common form of cyanotic heart disease with a prevalence between 3,5 to 8%. Anomalous coronary artery is reported in 2-23% of ToF patient. Knowledge of the coronary anatomy prior to surgery was important to avoid injury to the vessel. In our case, ToF with the presence of coronary artery that crossing the right ventricle outflow (RVOT) tract altered our strategy of surgery using right ventricle-pulmonary artery bypass (Rastelli procedure) in order to avoid injury to the vessel. Case report: A 2-yearsold boy was presented with repeated respiratory complaint and delayed both in growth and development. Cyanosis and clubbing fingers were observed in this patient. Overriding aorta and infundibular-valvular pulmonary stenosis were found on transthoracic echocardiography exam and additional finding was right coronary artery crossing the RVOT. The patient underwent total correction of ToF with additional procedure of the right ventricle to pulmonary artery bypass (Rastelli Procedure). The surgery was successful and the length of stay of the patient was eight days. One month following the surgery, we evaluated the flow in the conduit was preferable. The case represented the possible alternative management for ToF with anomalous coronary artery.

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Background Healthcare workers are still the front liners in health care services, and have major roles during the COVID-19 pandemic. In a resource-limited country like Indonesia, it is necessary to provide safe screening and management both for patients and healthcare workers to minimize the transmission. We report our experience in the cardiac surgery department on how to provide safe management during the COVID-19 pandemic. Methods A retrospective observational study was performed in a single-tertiary-center cardiac surgery department in Surabaya and included all patients who underwent cardiac surgery during the first year of the COVID-19 pandemic. We also collected the patients from a 1-year period before the pandemic as the comparison data. Analysis of the patient characteristics, operative data, and postoperative outcome, was performed. This study also provides our experience in changes of admission in the cardiac surgery preoperative system that can be utilized for others. Results A total of 179 patients were admitted to and had cardiac surgery. Of these, 3.80% ( n = 7) were COVID-19 confirmed by a real-time polymerase chain reaction. Five patients were delayed to have cardiac surgery with no mortality or morbidity reported in these patients. During the period after changes of admission procedural in cardiac surgery patients, there were no healthcare workers infected by COVID-19 by patient transmission in our center (0%). Conclusion Our study reported a systematic screening and that possible delay in cardiac surgery appears to be feasible and safe, both for patients and for healthcare workers during the COVID-19 pandemic.