1. Classification of CHD ASD & VSD: Pathophysiology, preopevaluation, Anaesthetic management for incidental surgery Dr.Nishad.P.K AIIMS, NewDelhi

8. Pathophysiology

11. Features of VSD based on size ↓ Yes Yes ↑ + None L->R R->L Large None No Yes ↑ + None R->L Large with ↑ PVR PSM Yes Mild mild↑ ± 20mmHg L->R Med PSM Yes No N ─ High L->R Small Murmur LVH RVH RVP ↑ PVR Gradient Shunt

12. Pathophysiologic classification of shunts SmallASD, VSD Relatively fixed,low to moderate volume,ind of PVR & SVR Small,restricted Restrictive Large ASD,VSD Variable,depends on PVR& SVR Large & unretsricted;pressures approx equal Dependent Examples Degree of shunt Features Type of shunt

16. ECG

23. IE Prophylaxis (contd…)

29. Cardiac Grid - ASD N N ↓ N to ↑ ↑ Res L->R shunt N N N N N Repaired N N ↓ N to ↑ ↑ Unrepaired Contractility HR SVR PVR Preload

30. Cardiac Grid - VSD N N N N ↑ Repaired N N ↓ N to ↑ ↑ Unrepaired Contractilit y HR SVR PVR Preload

33. At low Tidal volume: hypercarbia & atelectasis ↑ PVR At high tidal volume: large extra alveolar vesels are much compressed& ↑ PVR

39. Much more to come Are we all still awake?

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