There are over 100 different types of congenital heart disease that can be categorized into 9 major groups. The most common are ventricular septal defects (VSD), atrial septal defects (ASD), patent ductus arteriosus (PDA), and tetralogy of Fallot. For any congenital heart disease, the anesthesiologist must understand the pathophysiology of the defect and how changes in systemic and pulmonary vascular resistance may impact blood flow and oxygen saturation. The goal is to avoid maneuvers that could increase intracardiac shunting and hypoxemia based on whether it is a left-to-right or right-to-left shunt. Thorough preoperative evaluation including echocardi