Anesthesia for Right-sided Obstructive Lesions

Right-sided obstructive heart lesions contain various heart defects which present with a wide spectrum of physiological impact. Patients may present as neonates with severe congestive heart failure to adults with vague complaints of fatigue with exercise. Right-to-left shunting of blood can be evident due to the almost universally present septal defect. Obstruction to blood flow can occur in a single area or in combination with critical anatomical areas. These include the right atrioventricular valve, the outflow tract of the right ventricle, the pulmonary valve, and the main pulmonary artery and/or branch pulmonary arteries. Tetralogy of Fallot is an example of a specific combination of defects. Cyanosis may present from right-to-left shunting of blood through an atrial septal defect or patent foramen ovale in severe Ebstein's anomaly or through a ventricular septal defect as seen in tetralogy of Fallot. Some lesions with obstructive flow such as critical pulmonary valve stenosis or pulmonary valve atresia are patent ductus arteriosus dependent for blood flow through the lungs.