Anesthesia for Specific Cardiac Lesions: Right-to Left Shunts
Right-to-left shunting of venous blood away from the lungs occurs in a variety of congenital heart disease (CHD) lesions resulting in cyanosis. Cyanotic CHD can be divided into two basic categories: right-sided obstructive lesions which result in decreased pulmonary blood flow and intracardiac mixing lesions. The most common cyanotic lesions are Tetralogy of Fallot (TOF), transposition of the great arteries (TGA), truncus arteriosus (TA), total anomalous pulmonary venous return (TAPVR), and tricuspid valve abnormalities. Anesthetic implications vary based on the severity of the abnormalities present and the associated comorbidities, such as cardiac failure, arrhythmias, and pulmonary hypertension. The anesthesiologist must be aware of the hemodynamic consequences of the chosen anesthetic technique, as it relates to each specific lesion. This review focuses on the key principles of anatomy and physiology of right-to-left shunt lesions, as applicable to the safe anesthetic care for these complex patients.
KeywordsCyanosis Systemic vascular resistance Pulmonary vascular resistance Anesthesia
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