Congenital Heart Disease (Cyanotic & Acyanotic) and Shunt Lesions — WACS Viva & Clinical Scenarios (Cardiothoracic)

Exam-style congenital heart disease (cyanotic & acyanotic) and shunt lesions viva scenarios with examiner probes and model answers for ANAESTHESIA fellowship…

Scenarios covered

• SCENARIO 1: A 3-year-old boy (12 kg, ASA IV) with uncorrected Tetralogy of Fallot is scheduled for elective surgical correction. Upon arrival in theatre, he becomes agitated, deeply cyanotic, and his SpO2 drops to 45%. Outline your acute management of this hypercyanotic spell and your subsequent anaesthetic technique.
• SCENARIO 2: A 2-year-old child (ASA III) with a large non-restrictive ventricular septal defect (VSD) presents for VSD closure. Describe your strategy to manipulate the PVR/SVR ratio during the pre-bypass period to prevent worsening pulmonary oedema or systemic hypoperfusion.
• SCENARIO 3: A 28-year-old primigravida (ASA IV) at 32 weeks gestation with uncorrected ASD who has developed Eisenmenger's syndrome presents with acute obstructed labour requiring emergency Caesarean section. What are your anaesthetic considerations, haemodynamic goals, and choice of technique?
• SCENARIO 4: A 900g premature neonate with a haemodynamically significant Patent Ductus Arteriosus (PDA) failing medical closure is scheduled for surgical ligation in the neonatal intensive care unit (NICU). Detail your intraoperative management, thermoregulation, and post-ligation haemodynamic monitoring.