RIGHT TO LEFT SHUNT AND CYANOTIC

CONGENITAL HEART DISEASE

ANSHORIL ARIFIN
 DEFINITION

• A right-to-left shunt exists when a

volume of deoxygenated blood
(systemic venous return) travels
directly to the left atrium, left
ventricle, or aorta instead of traveling
through the lungs to be oxygenated.

• Increased of deoxygenated blood to

systemic resulting cyanosis.

Park, M.K. (2008) Pediatric Cardiology for Practitioners. 5th Edition, Mosby Elsevier, Philadelphia, 257-269.
 CYANOSIS

Cyanosis is bluish discoloration of the skin and mucous membranes resulting

from an increased consentration of reduced hemoglobin in cutaneous veins

This level reduced hemoglobin may result from either desaturation of arterial
blood or increased extraction of oxygen by peripheral tissue.

Cyanosis can be central cyanosis or peripheral cyanosis

Park, M.K. (2008) Pediatric Cardiology for Practitioners. 5th Edition, Mosby Elsevier, Philadelphia, 257-269.
 RIGHT TO LEFT LEFT TO RIGHT
SHUNT SHUNT

INCREASES
RVOT
PULMONARY
OBSTRUCTION
BLOOD FLOW

PAT H O P H Y S I O L O G
Y INCREASES RV
RV FAILURE INCREASES PVR
R-L SHUNT AFTERLOAD

PULMONARY
RV HYPERTROPHY
HYPERTENSION

FLOW TO LEFT
DEOXIGENATED
RV PRESSURE > LV SIDED (IF THERE
BLOOD TO
PRESSURE IS SEPTAL
SYSTEMIC
Andropoulos, D., Stayer, S., Mossad, E.B. and Miller-Hance, DEFECT)
W.C. (2015) Anesthesia for Congenital Heart Disease.
Houston Texas USA. 3rd Edition, Wiley Blackwell, New York,
590-597.
 CONSEQUENCES AND COMPLICATION

Brain abcess and

Polycythemia Clubbing
stroke

Hypoxic spell :
Bleeding
acute on chronic Scoliosis
disorder
complication

Park, M.K. (2008) Pediatric Cardiology for Practitioners. 5th Edition, Mosby Elsevier, Philadelphia, 257-269.
 C YA N O S I S I N
C A R D I O VA S C U L A R
 • Neurocognitive dysfucntion

CYANOSIS
TO OTHER
ORGANS
 HYPERCYANOTIC SPELL

• The tet spell (also called ”hypoxic spell”, “cyanotic spell”, hypercyanotic
spell”) is an episodic central cyanosis due to occlusion of right ventricle
outflow in patient with congenital heart disease such as TOF.

• Characterized by paroxysm hyperapnea (rapid and deep inspiration),

irritability, and increased cyanosis. If not treated in time, may lead to seizure,
hemodynamic instability, and death.
PATHOPHYSIOLOG
Y OF
HYPERCYANOTIC
SPELL
 MANAGEMENT OF HYPERCYANOTIC
SPELL
• Oxygen
• Increase SVR
• Phenylephrine 5-10 mcg/kg IV and titrate
• Norephynefrine 0,02-0,1 mcg/kg/minute and titrate
• Knee chest position
• Surgical compression of aorta
• Decrease Infundibular spasm
• Esmolol 50-200 mcg/kg IV and titrate to effect
• Propanolol 0,1 mg/kg given slowly (slower onset)
• Morphine 0,1 mg/kg IV
• Administer IV fluid to increases RV filling, potentially dilating of RVOT, and
optimally CO
CYANOTIC
CHD
DIAGRAM OF TETRALOGY OF FALLOT
 TRANSPOSITION OF GREAT ARTERY
Andropoulos, D., Stayer, S., Mossad, E.B. and Miller-Hance, W.C. (2015) Anesthesia for Congenital Heart
Disease. Houston Texas USA. 3rd Edition, Wiley Blackwell, New York, 590-597.
DIAGRAM OF
TGA
TRICUSPID
ATRESIA
PULMONARY ATRESIA
 DIAGRAM
OF
PULMONAR
Y ATRESIA
 TO TA L
A N O MA L O U S
VENOUS
R E T U RN
TERIMA KASIH