The anesthesiologist and the perioperative environment for the patient with congenital heart disease

The population of patients with repaired or palliated congenital heart lesions has dramatically expanded. Improved surgical procedures and perioperative care have enabled many to survive significantly longer. This is a small but emerging population that requires the anesthesiologist to completely understand the anatomy, physiology, and natural history of the specific disease in order to provide a safe anesthetic. Common hemodynamic issues in this patient population include myocardial dysfunction, pulmonary hypertension, and residual defects, including obstruction and shunting. Residual hemodynamic abnormalities must be understood with respect to the predictable physiological disturbances that occur during anesthesia and the surgical procedure.