Anesthetic and perioperative care of high-risk adults with congenital heart disease: Managing ventricular dysfunction and minimal reserve

The number of adults with congenital heart disease has increased dramatically in recent years owing to advances in the surgical and medical care of pediatric congenital heart disease, and these patients present with increasing frequency for both cardiac and non-cardiac surgical interventions. By adulthood, many demonstrate varying degrees of ventricular dysfunction and are at high risk for perioperative morbidity and mortality. Due to their limited cardiopulmonary reserve, physiologic insults are poorly tolerated and must be minimized throughout the perioperative period. An understanding of the altered cardiopulmonary physiology, unique complications, and overarching management goals for ACHD patients will allow anesthesiologists to coordinate optimal perioperative care for this challenging patient population.