Anaesthesia for correction of congenital heart disease (for the specialist or senior trainee)

Abstract

Congenital heart disease is common occurring in 1% of live births. The aim of surgery is to achieve a physiologically correct, biventricular repair. However, this is not always possible, and instead, a palliative approach may be required resulting in a single-ventricle circulation. Anaesthesia for correction of congenital heart disease requires an understanding of (i) the principles of neonatal and paediatric anaesthesia, (ii) the anatomy and physiology of congenital heart disease, (iii) the principles of cardiopulmonary bypass (CPB), and (iv) the expected postoperative complications of paediatric cardiac surgery. Success requires a multidisciplinary team approach. In addition to the anaesthetist, other key members are the paediatric cardiac surgeon, paediatric cardiologist, perfusionist, intensive care staff, and cardiac liaison nurses. Congenital heart disease can be classified in a number of ways. A simple physiological classification (based on shunt type and outflow tract obstruction) is helpful for anaesthesia as shown in Table 1.