A 30-hour-old male alpaca cria was presented to the Internal Medicine Service at Cornell’s Equine and Farm Animal Hospital for profound lethargy noted by his owners at birth. He had been born at term without difficulty. On presentation, the cria was obtunded, tachypneic, tachycardic, hypothermic, and had injected mucous membranes. His lung sounds were harsh but auscultable over all fields and he displayed significant abdominal respiratory effort. Bloodwork revealed a severe hypoxemia and lactic acidemia with hyperventilation that progressed throughout his stay. Respiratory disease was not evident on thoracic ultrasound or radiographs. Despite intensive nursing care, the cria became cyanotic and began to hyperventilate. A bubble study revealed a right-to-left shunt and the cria was euthanized due to the poor prognosis associated with his condition. A diagnosis of Tetralogy of Fallot was made on necropsy. This congenital defect has never been formally reported in the literature in a camelid species.