[Noncardiac surgery and congenital heart diseases: pathophysiological approach]

Abstract

Aim of this paper is to describe an approach to the patient with congenital heart disease (CHD) who is undergoing noncardiac surgery. Emphasis is placed on the pathophysiology of the lesion in order to facilitate the development of an anesthetic planning. There are three general categories of CHD: obstructive lesions, increased pulmonary blood flow lesions and decreased pulmonary blood flow lesions. Alterations in systemic and/or pulmonary vascular resistances lead to alterations in the quantity of pulmonary blood flow and the ventricles' ability to pump against an obstruction. Selection of anesthetic medications which preserve ventricular function and vascular resistances in a fashion which best maintain pulmonary blood flow and oxygenation and forward cardiac output are the anesthesiologist's goals. No single simple unified approach can be taken when providing anesthesia for the patient with CHD for noncardiac surgery; however, by evaluating each patient's hemodynamic needs in relation to hemodynamic variables which the anesthesiologist may control, a rational and individualized approach can be developed.