Anaesthesia for non cardiac surgery in patients with grown-up congenital heart disease

Objectives. - To be aware of the different grown-up congenital heart diseases. To know their physiopathology, adverse event's and the way to manage patients presenting with these pathologies in the anaesthesia for non cardiac surgery setting. Data source. - References were obtained from Pubmed data bank (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) using the following keywords: congenital heart disease, congenital cardiac disease, atrial septal defect, ventricular septal defect, Eisenmenger syndrom, cavopulmonary shunt, tetralogy of fallot, endocarditis. Data synthesis. - Nowadays, there are equal numbers of adults and children with congenital heart disease. These patients can be divided into three different groups: patients with corrective surgery, patients with palliative surgery, and patients with uncorrected congenital heart disease. In the non cardiac surgery setting, anaesthetists will have to cope with increasing number of adult patients with grown-up congenital heart disease. Because of the complexity and the severity of these lesions it is highly recommended to contact referral centers for the management of these patients. The most frequent complications in this setting are: arrhythmia, hypoxia, cardiac failure, and paradoxal air embolism. Anaesthesia management in this setting requires perfect comprehension of the physiology and anatomy. For the most severe pathologies, it is recommended to refer these patients to referral centres. (c) 2007 Elsevier Masson SAS.