Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 130: Adults with Congenital Heart Disease with Jochen Steppan
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Jul 22, 2019 Jochen Steppan, a cardiac anesthesiologist specializing in perioperative care for adults with congenital heart disease. He covers classification by physiology, perioperative risks and evaluation essentials. Practical strategies for shunts, cyanotic lesions, obstructive lesions, and Fontan physiology are discussed. Emphasis on multidisciplinary planning, tailored monitoring, and optimization for complex cases.
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Classify By Physiology Not Detailed Anatomy
- Categorize patients by physiology: obstructive lesions, pulmonary hypertension/right failure, shunts, or single-ventricle/Fontan.
- Use the physiological category to guide anesthetic goals rather than memorizing detailed anatomy.
Avoid Air And Use Filters For Patients With Shunts
- Prevent paradoxical emboli in unrepaired intracardiac shunts by meticulous IV technique and consider IV bubble/air filters.
- Recognize large left-to-right shunts can reverse (Eisenmenger) and change management entirely.
Pulse Oximetry Changes Reflect Shunt Not Just Lungs
- Pulse oximetry changes can reflect shunt dynamics rather than ventilation.
- In left-to-right shunts oximetry rises under anesthesia; in right-to-left lesions maintain patient-specific baseline saturations to avoid volume overload or worsened shunting.
