Abstract Background: Advances in surgical and medical management have improved survival in complex congenital heart disease (CHD), and adult anesthesiologists increasingly encounter these patients in non-cardiac procedures. Understanding the physiologic impact of unique CHD cases and how anatomy alters optimal management is essential. Case Presentation: A 55-year-old woman with complex cyanotic CHD presented for removal and washout of a left lower extremity external fixator. Her cardiac anatomy included HLHS, dextrocardia, criss-cross atrioventricular valves, a large ventricular septal defect, two prior Blalock-Taussig (BT) shunts, an aortic shunt, and reduced EF. Notably, she had undergone only stage I palliation of HLHS. Baseline oxygen saturation was 75–85% on 4L nasal cannula. Comorbidities included HFrEF of the single ventricle, chronic hypoxia, hypertension, and a remote cerebrovascular accident (CVA). Conclusion: This case demonstrates the need for general anesthesiologists to understand the physiologic ramifications of CHD and recognize that anatomic variations may affect ideal management.
Nagra et al. (Wed,) studied this question.