anaesthesia management of case of atrial septal defect (cardiac disease) for proximal humerus fracture (non-cardiac case)

Atrial septal defect is most common congenital developmental acyanotic cardiac anomaly. there is left to right shunt of blood in normal compensated state. in decompensated state, the shunt is reversed and flow is from right to left side causing heart failure and thrombo-embolic event. here, we report a case of humerus fracture with large asd, managed under general anaesthesia with interscalene block without any deleterious effects like venous air embolism, spontaneous reversal of shunt etc. as patient was in beach chair position.