Tetralogy of fallot is the most common congenital heart disease with right to left shunt. Incidence is about 10% of all congenital heart diseases and has a dilated aorta which overrides the ventricular septal defect, right ventricular tract obstruction and right ventricular hypertrophy. Brain abscess is associated with 13-70% cases of tetralogy of fallot. We hereby present a case of 8 year boy presented to emergency with complaints of headache, vomiting, fever since 5 days and history of dyspnea on exertion (NYHA III). Patient was taken up for emergency surgery under general anaesthesia on double ionotroic support (dopamine and dobutamine @ 10ug/kg/min). Patient was Shited to paediatric ICU with ionotropic and ventilatory support.