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Classification

Congenital heart diseases are normally classified according to their impact on pulmonary blood flow (normal, reduced, or high), or whether or not cyanosis is present. We will address this later in the general considerations for anaesthesia. For the moment, we will follow the anatomical sequence by segment and examine the specificities of the various disorders and their impact on the approach taken by the anaesthetist. There is no question of running through all the numerous existing cardiac anomalies here. Therefore, only the most commonly observed disorders in adults will be addressed. 
 
  • Anomalous venous return;
  • Atrial septal defect and patent foramen ovale;
  • Atrioventricular canal defect;
  • Ebstein anomaly;
  • Ventricular septal defect;
  • Ventricular hypoplasia and Fontan physiology;
  • Tetralogy of Fallot;
  • Mixed shunts;
  • Pulmonary stenosis;
  • Anomalies of the LV ejection pathway;
  • Transposition of the great arteries;
  • Congenitally corrected transposition of the great arteries;
  • Coarctation of the aorta;
  • Arterial abnormalities.
For further information, reference may be made to Chapter 14 (Paediatric cardiac surgery). Illustrations are taken from transesophageal echocardiography (TEE), which anaesthetists may perform in the operating theatre.

 
 
 
 
 
 
 
© BETTEX D, CHASSOT PG, January 2008, last update May 2018

 
15. Anesthesia for adult congenital heart disease patients