Atrial septal dejects (ASD): Most ASD’s have left to right shunt and may
present with right ventricular volume overload. Other lesions that mimic physiology of
ASD include partial anomalous pulmonary venous return, LV to RA shunt.
Most common post-operative problems in ASD are atrial dysrhythmias and left
ventricular noncompliance. Certain types of ASD may be predisposed to certain
operative issues. For instance, coronary sinus ASD may be more predisposed to heart
block, sinus venosus ASD may have SA dysfunction and SVC narrowing, IVC type
ASD may have cyanosis (baffling) and primum ASD may have mitral valvular
problems.
Ventricular septal defects (VSD) also have left to right shunting preoperatively.
This manifests as increased pulmonary blood flow and subsequent left ventricular
overload since shunting occurs during systole. Lesions with similar pathophysiology
include large ductus arteriosus and aortopulmonary window. Post-operative problems
encountered include junctional ectopic tachycardia (RR 7180bpm, AV dissociation), or
heart block.
AV canal is a lesion by which blood mixes in a common chamber. There is
increased pulmonary blood flow and pressure. There may be biventricular overload
and AV regurgitation. Postoperative issues may include pulmonary hypertension, AV
valve regurgitation, heart block and junctional ectopic tachycardia.