Anesthesia in adults with congenital heart disease

Abstract

Advances in medical, interventional, and surgical care of patients with congenital heart disease (CHD) over the past five decades have led to the survival of this population group to adulthood. Consequently, the number of adults with CHD is expected to exceed that of the related pediatric population. Most of these patients will need cardiac or noncardiac surgery within their life, thus presenting anesthesiologists with new challenges. Adulthood CHD (ACHD) is accompanied by profound alterations in the cardiopulmonary anatomy and physiology; therefore, anesthetic management of this patient requires a comprehensive knowledge of pathophysiological changes in cardiovascular and respiratory systems. A cardiac anesthesiologist in approach to ACHD patient requires taking a complete medical history and physical exam and obtaining a comprehensive paramedical evaluation including laboratory testing and cardiac imaging. Regarding more frequency of craniofacial anomalies, airway management may be challenging. In ACHD with mixing lesions, all intravenous tubing must be free of air bubble because of probability of systemic air emboli. Polycythemic patient must be adequately hydrated or undergo phlebotomy before induction to maintain hematocrit <65 %. A complete monitoring system including invasive arterial, pulmonary, and venous pressure measurement and intraoperative transesophageal echocardiography is needed for close and accurate hemodynamic surveillance in complex CHD undergoing major surgery. For proper managing of such patients either for surgical procedures, a multidisciplinary approach including an adult CHD expert cardiologist, a cardiac surgeon, and a cardiac anesthesiologist is needed in regional specialized center. This chapter reviews the perioperative anesthetic implications of adult patients with CHD undergoing cardiac or noncardiac surgery.