Central shunts are artificial connections between the systemic and the pulmonary circulation to provide pulmonary blood flow. This is usually part of a complex repair or a palliative operation for patients in whom complete repair is not possible. There are several different types, depending on the anatomy and blood vessels involved. In a L → R shunt a decrease in pulmonary vascular resistance and an increase in systemic vascular resistance should be avoided. Anaesthetic management might be different if shunt is part of a complex repair.