Non-Cardiac Surgery in Adults with Congenital Heart Disease

Progress in the surgical and cardiologic treatment of congenital heart disease brings more and more patients into adulthood, even those with complex heart defects. General, orthopaedic or abdominal surgery in this patient group is a demanding field for those who provide medical care for these patients. Besides the univentricular hearts after palliative surgery (Fontan operation) and patients with Eisenmenger syndrome even the corrected congenital heart defects may suffer from sequelae of longstanding pressure or volume load of the heart. A detailed preoperative evaluation has to be accomplished before a noncardiac operation. The anaesthesiologic management focuses on changes of pulmonary and systemic vascular resistance. Special characteristics of ventilation, volume shifts, secondary organ dysfunction, erythrocytosis, thrombopenia and coagulation disorders, as well as altered drug metabolism, especially in cyanotic patients are the relevant aspects of perioperative care. The risk for arrhythmia, indication for endocarditis prophylaxis and the differential use of common heart failure treatment must be evaluated in time before the operation is performed, based on a multidisciplinary dialogue between cardiologists, surgeons and anaesthesiologists. The special expertise of physicians trained in treatment of grown ups with congenital heart disease (GUCH) coming from paediatric or internal cardiology and the location in GUCH- centres reduce the risk for patients.