Anesth Pain Med.  2021 Jan;16(1):1-7. 10.17085/apm.20090.

Who are at high risk of mortality and morbidity among children with congenital heart disease undergoing noncardiac surgery?

• Song IK
• Shin WJ

• KMID: 2512277
• DOI: http://doi.org/10.17085/apm.20090

Abstract

With advances in the development of surgical and medical treatments for congenital heart disease (CHD), the population of children and adults with CHD is growing. This population requires multiple surgical and diagnostic imaging procedures. Therefore, general anesthesia is inevitable. In many studies, it has been reported that children with CHD have increased anesthesia risks when undergoing noncardiac surgeries compared to children without CHD. The highest risk group included patients with functional single ventricle, suprasystemic pulmonary hypertension, left ventricular outflow obstruction, and cardiomyopathy. In this review, we provide an overview of perioperative risks in children with CHD undergoing noncardiac surgeries and anesthetic considerations in patients classified as having the highest risk.

Keyword

Anesthesia; Child; Congenital heart defect; Risk

Figure

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  Fig. 1. Requirements for a perfect Fontan circulation. Factors at each anatomical structure are essential to secure successful Fontan circulation: an adequate preload, low pulmonary vascular resistance (PVR), normal sinus rhythm, normal atrioventricular valve function, good ventricular contractility, and absence of inflow and left outflow tract obstruction (LVOTO).

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  Fig. 2. A vicious cycle of pulmonary hypertensive crisis. During general anesthesia and surgical procedures, conditions of hypoxia, hypercarbia, acidosis, hypothermia, and sympathetic stimulation can induce a further increase in pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR), thereby triggering a vicious cycle of pulmonary hypertensive crisis. SAP: systemic artery pressure.

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