With the rising incidence of congenital heart disease in adults, an understanding of the patient’s physiology and anesthetic implications is critical for anesthesiologists. Adult patients with CHD fall primarily into three major categories: those with prior complete correction of their congenital defect, those with partial or palliative correction, and those patients who are diagnosed in adulthood without any childhood surgical intervention. In general, heightened concern for arrhythmias, ventricular dysfunction, pulmonary hypertension, cyanosis, and hypoxemia must be considered. While the underlying anatomy may often be complex and the evolution of the disease from childhood to adulthood results in unique physiology, CHD can further be divided into several physiologic categories that aid in the approach to perioperative management. The table at the end provides information about common lesions and their anesthetic considerations.
Shunt fraction Atrial septal defect Ventricular septal defect Coarctation of aorta Tetralogy of Fallot Fontan circulation Eisenmenger’s
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