• Paediatric Cardiac
• Congenital heart disease
• Occurs in 1% of all live births
  Can be associated with syndromes e.g. Down's syndrome (AVSDs), Turner's (coarctation).
• Associated with maternal diabetes, SLE, autoimmune conditions, family history, anti-epileptics, illegal drugs, alcohol
• Commonest are:
  VSDs (30%)
  PDA (9%)
  ASD (7.5%)
• Cyanotic (right to left shunt)
• Complications of R to L shunt
  Polycythaemia
  Heart failure
  Paradoxical embolism
  CVA
  Brain abscess
  Infective endocarditis
  Failure to thrive
• TOF
• Pulmonary atresia and physical obstruction means blood shunts from R to L
• Pulmonary atresia
• TGA
• TAPVD
• Acyanotic (left to right shunt)
• ASD
• VSD
• PDA
• Pulmonary overflow can lead to pulmonary oedema, PAH and eventually R heart failure. The pressure in the right side can then exceed the left and cause shunt reversal - Eisenmenger's syndrome
• Duct dependent lesions
• Remember: flows across ducts or defects can reverse in light of reduced SVR or increased PVR.
• Conditions include pulmonary atresia, TOF, TGA and severe coarctation.
• Present with symptoms of cold, clammy, peripherally shut down, peri-arrest
• PGE1/2 are used to open the duct or radiologically guided stents.
• Fontan Circulation
• Univentricular circulation where blood returns from the vena cavae directly to the pulmonary artery and passes through the lungs until it is returned and pumped to the rest of the body by the remaining ventricle.
• As such, the preload to the systemic circulation depends on adequate passive return of blood so the patient needs adequate fluid resuscitation
• Excessive increases in PVR should be avoided as the flow across the lungs depends on the vena cava pressure and the single artium. As such IPPV should be avoided if possible.
• CEACCP
  Link:ceaccp.oxfordjournals.org/content/early/2011/12/20/bjaceaccp.mkr049.full.pdf