Perioperative Issues in Patients with Congenital Heart Disease

Scope of the Problem The population of children and adults who have undergone successful palliation of various forms of congenital heart disease (CHD) continues to increase and live longer. The reasons are multiple, and include expanded indications, early, more definitive surgery and other interventional techniques, and improved surgical, interventional, catheterization, electrophysiological, and intensive care management. The numbers are not entirely clear and based upon certain assumptions, but current estimates suggest that there are at least 1.2 million adults (>16 yr) living with various forms of CHD (ACHD) in the US. Of these, perhaps as many as 80-100,000 have complex forms (defined as lesions other than repaired secundum or sinus venosus ASD without residuae [incl. pulmonary hypertension or dysrhythmias], isolated PFO or small ASD, mitral valve prolapse, mild pulmonic stenosis, ligated or occluded PDA, congenital aortic valve disease [isolated, mild gradient, without aortic root dilation, without prior intervention], isolated restrictive or repaired VSD]) (1).