A 10 months old infant underwent repair of tetralogy of Fallot with hypoplastic annulus of the pulmonary valve,
diminutive pulmonary arteries, right aortic arch and left superior vena cava. The right ventricular outflow tract was
reconstructed using a monocusp patch. The postoperative course was unfavourably influenced by respiratory
complications due to tracheal bronchus and hypoplasia of trachea, which were not diagnosed preoperatively. Extreme
emphysema of the right upper andmiddle lobes compromised haemodynamics. Repeated reoperations were required.
The upper and the middle lobes of the right lung had to be resected, the hypoplastic trachea reconstructed with
a pericardial patch and pulmonary homograft inserted. One year later, homograft had to be replaced and tricuspid
annuloplasty performed for pulmonary and tricuspid regurgitation and right ventricular dilatation as a consequence
of increased pulmonary artery pressure. Three years after the original surgery the patient remains in good clinical
congenital heart disease, tetralogy of Fallot, hypoplastic trachea, tracheal bronchus, patch repair of
trachea, heart surgery, complication, reoperation, child, infant.