This is a left-to-right (acyanotic) heart defect. Broad anesthetic implications of acyanotic congenital heart defects (CHD) include:

Get a detailed medical history – understand all you can about what defect the patient has and how severe the symptoms are. Get surgical history, daily medications, hemodynamic status, and cardiac and lung function.

Reduce left-to-right shunt – Increases in SVR will worsen left-to-right shunting. Sudden increases or decreases in pulmonary vascular resistance or SVR will also be tolerated poorly. Volatile anesthetics, propofol, etomidate, and barbiturates all decrease SVR – so use cautiously.

Limit stress – or anything that would stimulate sympathetic response. Opioids are often used to reduce/eliminate sympathetic responses to pain, laryngoscopy, etc. Use a slow/cautious induction.

Maintain MAP and SVR – Arterial lines and/or central lines are ideally employed to keep tight controls. These patients will not have optimal cardiac reserve.

Avoid shunt reversal – Airway obstruction, hypoventilation, hypoxia, and pulmonary hypertension create greater pressures on the right side of the heart and can reverse the shunt (making it a cyanotic shunt). This is otherwise called Eisenmenger Syndrome.

Debubble – avoid any bubbles in venous lines. These can lead to a paradoxical embolus.

Cardiac bypass – complex congenital defects sometimes require this. Be aware that this may result in hemodilution!

Endocarditis prophylaxis – for 6 months post-surgical repair of the cardiac defect.

This acyanotic congenital heart defect is characterized by communication between the main pulmonary artery and the aorta. This communication is very often the source of cardiopulmonary deterioration of premature infants.

Occasionally, it presents later in life and can be corrected thoracoscopically.