Anaesthesia for children with congenital heart disease undergoing non-cardiac surgery

By reading this article you should be able to: Identify factors for high-risk patients with congenital heart disease (CHD) presenting for non-cardiac surgery.Recognise the long-term sequelae commonly associated with CHD.Comprehend the pathophysiology of postoperative complications associated with CHD.This article reviews the epidemiology, pathophysiology, diagnosis and risk of perioperative complications of children with congenital heart disease (CHD) undergoing non-cardiac procedures.We provide guidance on the perioperative management of both routine and complex paediatric cases with a focus on information important to general anaesthetists.We highlight key aspects required for the safe care of these patients while emphasising communication and collaboration with our colleagues in cardiac anaesthesia and cardiology. EpidemiologyCongenital heart disease includes a spectrum of structural cardiac abnormalities that arise before birth because of abnormal fetal cardiac development; it does not include hereditary disorders with cardiac manifestations such as Marfan's or hypertrophic cardiomyopathy. 1 Congenital heart disease affects ~8% of the population worldwide with the most common lesions being atrial and ventricular septal defects (ASD and VSD, respectively). 2 Risk factors for CHD are multifactorial, including genetic disorders, maternal disease and medication/chemical exposure in utero.With improvements in medical and surgical care, >90% of patients with CHD will survive into adulthood.3 In addition to cardiac procedures, children with CHD may need anaesthesia for non-Joshua Spiro MD is an assistant professor in paediatric anaesthesiology who specialises in paediatric general anaesthesia and in anaesthesia for children with complex diseases at the St. Louis