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anesthesia for the patient with congenital heart disease presenting for noncardiac surgery

Kelly J Zach, Harish Ramakrishna, Krishnashwamy Chandrasekaran, Ricardo A Weis
Increasing numbers of adult patients with complex congenital heart conditions are presenting for noncardiac surgery later in life. These disorders can present challenges for surgical and anesthesia providers. Specifically, single ventricle lesions offer anatomic and physiologic concerns during the perioperative period. Single ventricle physiology represents a delicate balance between systemic and pulmonary blood flow. Any alterations in blood flow through these systems can produce undesirable hemodynamic changes, especially during the perioperative period...
April 2015: Annals of Cardiac Anaesthesia
Laura Downey, Samuel Rodriguez, David Clendenin
We present the case of a 20-year-old woman with a history of hypoplastic left heart syndrome, D-transposition of the great arteries, and mitral/pulmonary valve atresia without surgical palliation, who was admitted with persistent atrial flutter/fibrillation and worsening cardiac function from amiodarone-induced thyrotoxicosis. Despite maximal medical therapy, she continued to have uncontrolled thyrotoxicosis and underwent successful emergent thyroidectomy under general anesthesia. With advances in the treatment of congenital heart disease, more patients are surviving to adulthood and require emergent noncardiac surgery...
September 1, 2014: A & A Case Reports
Bryan G Maxwell, Glynn D Williams, Chandra Ramamoorthy
OBJECTIVE: To examine the knowledge and attitudes of anesthesia providers in relation to the care of adult congenital heart disease (ACHD) patients presenting for noncardiac surgery. DESIGN/SETTING: A novel survey was designed and administered to 168 anesthesiologists across a single academic department in a range of practice environments. INTERVENTIONS: None. OUTCOME MEASURES: Survey responses, including true/false, multiple choice, and Likert scale questions...
January 2014: Congenital Heart Disease
Erin A Gottlieb, Dean B Andropoulos
PURPOSE OF REVIEW: To summarize recent publications emphasizing the changes in the population of patients with congenital heart disease and trends in the anesthetic and perioperative care of these patients presenting for noncardiac procedures. RECENT FINDINGS: It has been reported that children with congenital heart disease presenting for noncardiac surgery are at an increased anesthetic risk. This risk has become better defined. The patients at highest risk are infants with a functional single ventricle and patients with suprasystemic pulmonary hypertension, left ventricular outflow tract obstruction or dilated cardiomyopathy...
June 2013: Current Opinion in Anaesthesiology
Scott C Watkins, Brent S McNew, Brian S Donahue
BACKGROUND: Children with complex congenital heart disease entail risk when undergoing noncardiac operations and other procedures requiring general anesthesia. To address concerns regarding intraoperative instability, need for postoperative mechanical ventilation, and postoperative hospital length of stay (LOS), we present our 5-year experience with 71 patients with complex congenital heart disease who underwent 252 surgical procedures. METHODS: We reviewed the records of all patients from July 2006 to January 2011 who underwent a cardiac procedure with a Risk Adjustment for Congenital Heart Surgery-1 score of 6, and included all who underwent noncardiac procedures during this interval...
January 2013: Annals of Thoracic Surgery
Dusica Simić, Milan Djukic, Ivana Budić, Irina Milojević, Veljko Strajina
Children with Congenital Heart Disease (CHD) presenting for non-cardiac surgery have various physiological and functional abnormalities and thus pose great challenges to the anaesthesiologist. The principles of anaesthesia are to minimize pathophysiological changes which may upset the complex interaction between systemic and pulmonary vascular resistance. Knowledge of the specific cardiac anatomy, familiarity with the modifications of the cardiorespiratory physiology, the awareness of the potential risks of complications for each individual case are mandatory for the choice of the anaesthesia strategy for each patient...
January 2011: Srpski Arhiv za Celokupno Lekarstvo
Koichi Yuki, Alfonso Casta, Shoichi Uezono
Patients with congenital heart diseases are a growing population, and noncardiac surgeries will become an important health care issue. Patients with single ventricle physiology are a particularly challenging population who will undergo staged, palliative repair toward a final step of Fontan circulation. Although Fontan surgery creates a serial circulation in which the ventricle pumps blood to the systemic circuit, pulmonary blood flow occurs without a dedicated ventricle. Despite progress in outcomes, this abnormal circulation remains associated with various co-morbidities such as ventricular dysfunction, arrhythmias, protein losing enteropathy, and plastic bronchitis...
April 2011: Journal of Anesthesia
Takashi Fujii, Soichi Shirakawa, Yasushi Matsuura, Shunsuke Yamamoto, Takekazu Terai
Advances in the surgical and medical management of children with congenital heart disease have decreased the mortality of these patients. As a result, more patients are surviving into adulthood and are presenting for noncardiac surgery. We experienced a case of anesthetic management of an adult patient with Fontan circulation for laparoscopic surgery. A 29-year-old woman was scheduled for laparoscopic cholecystectomy for gallbladder stone. She had undergone single-ventricle procedures for a tricuspid atresia, and at the time of the laparoscopic surgery, her cardiac physiology was Fontan circulation...
August 2010: Masui. the Japanese Journal of Anesthesiology
Maxime Cannesson, Vincent Collange, Jean-Jacques Lehot
PURPOSE OF REVIEW: Recent advances in prenatal diagnosis, interventional cardiology, pediatric cardiac surgery, anesthesia, and critical care have resulted in an increasing number of adult patients with congenital heart disease (CHD). Most of these patients will require noncardiac surgery thus presenting a new challenge for anesthesiologists. The purpose of this article is to summarize preoperative and intraoperative implications for the anesthesiologist in the noncardiac surgery setting...
February 2009: Current Opinion in Anaesthesiology
Robert Sümpelmann, Wilhelm Alexander Osthaus
PURPOSE OF REVIEW: To summarize results of recent papers and discuss current trends concerning anesthesia in children with congenital heart disease presenting for noncardiac surgery. RECENT FINDINGS: Children with congenital heart disease have a significant incremental risk when presenting for minor or major surgery. It is a current trend that noncardiac surgery should be performed in pediatric centers, which have anesthesiologists and pediatricians familiar with the multiple specialties of children with congenital heart disease...
June 2007: Current Opinion in Anaesthesiology
V C Baum, J K Perloff
In adults with congenital heart disease who are confronted with noncardiac surgery, perioperative risks can be reduced, often appreciably, when problems inherent to this patient population are anticipated. The first necessity is to clarify the diagnosis and to be certain that appropriate information is obtained from a cardiologist with adequate knowledge of congenital heart disease in adults. Physiology and anatomy can vary significantly among patients who superficially carry identical diagnoses and would seem to fit under the same rubric...
June 1993: Anesthesia and Analgesia
K A Haselby, S S Moorthy
The patient with congenital heart disease who presents for noncardiac surgery requires careful evaluation and planning to avoid adverse perioperative events. This chapter presents a physiological approach to the management of anesthesia for the most common congenital heart lesions. The various congenital heart defects are categorized into lesions resulting in: (1) left-to-right shunting; (2) right-to-left shunting; (3) complete mixing of pulmonary and systemic circulation; (4) complete separation of the pulmonary and systemic circulations; (5) increased myocardial work; and (6) mechanical obstruction of the airway...
February 1992: Seminars in Pediatric Surgery
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