1 Spot the diagnosis
#echocardiography #echofirst #CardioTwitter #echocardiogram #transesophageal #scary_movie_cardio #paediatrics #anaesthesia #anesthesiology @swatigar @cardiopedhnn @fpmorcerf @donoxorn @CardioNeo @TangariElsa @alexsfelixecho @22tabbah_randa @RODRIGOVISCONT1

2. When our smallest patients with missing chambers need us the most to keep the fragile balance and provide them a secure #anesthesia. What are the essential implications & goals for general anesthesia in univentricular hearts such as #HLHS? A thread

3. Hypoplastic left heart syndrom is life threatening congenital disorder that needs immediate treatment.The surgical correction consists of 3 steps that should be completed by age of 6y providing serial circulation
Norwood (Sano/BT)
Glenn anastomosis (PCPC)
Fontan (TCPC)

4. Making the single chamber a systemic ventricle and a pulmonary blood supply completely passive can pose a lot of problems such as protein loss enteropathy, liver congestion, lymphatic drainage disorders etc. which makes the patients prone to gastroesophageal reflux and

5. Very unpredictable in terms of pharmacokinetics of local anesthetics.The golden standard remains general anesthesia with a few things to keep in mind:
If Fontan isn't completed mild hypoxaemia must be accepted during GA and FiO2 kept as low as possible&as high as necessary

6. A continuous normocarbia should be established.CO2 could increase PVR and so aggravate hypoxaemia
Bleeding complications due to anticoagulation therapy must be considered
Since the pulmonary blood flow is proportional to a venous return a normovoalemia is crucial

7.And must be addressed with volume substitution after preop fasting
Venous return must be warranted at any time independently of patients position or type of operation
Keep PEEP
Last but not least keep the systemic pressure stable even though it may require inotropes