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Anesthesia for adults with congenital heart disease undergoing noncardiac surgery

Edmund Jooste, MB, ChB
Kelly Machovec, MD, MPH
Section Editors
Jonathan B Mark, MD
Lena S Sun, MD
Heidi M Connolly, MD, FASE
Deputy Editors
Nancy A Nussmeier, MD, FAHA
Susan B Yeon, MD, JD, FACC


Congenital heart disease (CHD) is present in approximately 6 to 19 of 1000 live births [1]. In the United States, approximately 1,000,000 pediatric and adult patients have CHD, with a growing number surviving into middle age and beyond [1,2]. Many of these patients require anesthetic care for either cardiac or noncardiac surgery. The anesthesiologist should understand the patient's native CHD lesion and prior palliation or repair, current cardiopulmonary reserve, and potential adverse effects of the planned surgical procedure in order to assess risk and develop an anesthetic plan appropriate for lesion-specific hemodynamic goals.

This topic will discuss the anesthetic management of adult CHD patients undergoing noncardiac surgery. Anesthetic management during labor and delivery for women with congenital and other high-risk heart disease is discussed separately. (See "Anesthesia for labor and delivery in high-risk heart disease: General considerations" and "Anesthesia for labor and delivery in high-risk heart disease: Specific lesions".)


The history focuses on the native congenital heart disease (CHD) lesion, prior palliative or reparative procedures, and current functional status (eg, exercise tolerance and symptoms of heart failure). The physical examination focuses on signs of cyanosis or heart failure.

Also noted are noncardiac sequelae of CHD such as developmental delay and disability, or presence of an associated genetic syndrome (eg, Down or Williams syndrome).

High- and moderate-risk lesions — CHD patients with high and moderate risk are ideally managed at a center with expertise in the care of adult patients with CHD, particularly if a major surgical procedure is planned [3]. Such patients may require advanced monitoring and other specialized management during the procedure. (See 'Monitoring' below and 'Anesthetic management' below.)


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Literature review current through: Sep 2016. | This topic last updated: Jul 27, 2016.
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