Anesthetic management of adults with congenital heart disease

Abstract

Congenital heart defects constitute the most common type of birth defects and occur in approximately 8 in 1000 live births. With the exclusion of bicuspid aortic valve disease, the majority of untreated patients born with congenital heart disease (CHD) expire in childhood with approximately 15-25 % surviving into adulthood. Significant advances in prenatal diagnosis, interventional cardiology techniques, congenital heart surgery, anesthesiology, and critical care have allowed approximately 90 % of these patients to survive into adulthood. The profile of patients with congenital heart disease has evolved, and now there are estimates to suggest that in the United States, there are more adults than children living with congenital heart disease. Most of these patients will require additional interventional cardiology or cardiac surgical procedures either palliative or curative during adulthood. Although major studies evaluating this population have not been done, adults with CHD are a medically fragile group, which have an increased risk for perioperative morbidity and mortality. Formal guidelines which direct the management of these patients have not been developed; however, the American College of Cardiology recommends that adult patients with moderate to severe CHD be referred to a center specializing in the care of these patients and receive expert consultation with the appropriate care providers such as adult congenital heart cardiologists, surgeons, and anesthesiologists prior to undergoing procedures.