Adult Congenital Heart Disease (CHD)

 

 

Anesthetic Considerations

 

  • Long term consequences of CHD:

    • Cardiac: pulmonary hypertension, heart failure, arrhythmias, residual shunts, valvular lesions

    • Non-cardiac: erythrocytosis, cholelithiasis/nephrolithiasis, developmental abnormalities, seizure disorder, CVA, chronic lung disease

  • Endocarditis prophylaxis

  • Management of medications, especially anticoagulants

  • Lesion-specific anesthetic goals & management

  • ↑ perioperative risk requiring multidisciplinary care

 

 

Goals & Conflicts

 

  • Preoperative assessment of cardiac & non-cardiac complications

  • Considerations of surgical stress & positioning

  • Lesion-specific hemodynamic goals with focus on PVR, SVR, preload, contractility, HR

  • Need for invasive monitoring including arterial line & central line placement

  • De-airing of lines

 

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