A 9-year-old boy underwent tetralogy of Fallot (TOF) correction and arterial duct closure surgery at 6 months old. He was admitted to our hospital due to worsening cyanosis of the lips, shortness of breath, and eyelid and facial edema after the respiratory tract infection. He was treated with inotropes, diuretics, and mechanical ventilation. He underwent right ventricle-pulmonary artery conduit replacement after the cardiac function was improved. In this case, the anesthetic management should focus on adjusting preoperative cardiac function, infection control, intraoperative monitoring, rational use of inotropes and fluid replacement, and avoiding aggravation of right heart dysfunction.