Noncardiac surgery in patients with congenital heart disease requires lesion- and physiology-specific planning. Determine residual obstruction, shunt direction, ventricular function, pulmonary vascular disease, rhythm risk, and procedural stress before selecting surgical setting, monitoring, anesthesia, and postoperative disposition.

Preoperative Triage

Select the care setting from present physiology, not repair history

Classify the current circulation before accepting elective surgery.

Obtain the operative reports, most recent congenital cardiology assessment, ECG, echocardiogram, catheterization data when relevant, baseline oxygen saturation, hemoglobin concentration, medication list, and prior anesthesia record. The preoperative question is whether repair is anatomically and physiologically complete or whether residual obstruction, regurgitation, shunting, ventricular dysfunction, arrhythmia, pulmonary hypertension, cyanosis, or a palliated circulation remains.AHA Journals+1AHA Journals2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the ...PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

Patients with complete anatomic repair and no functional deterioration may often undergo conventional anesthetic management. In contrast, complex congenital heart disease, palliative procedures, or interventional repairs require individualized monitoring and hemodynamic planning because the prior operation does not establish normal physiology.PubMedPubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

Route patients with complex disease, heart failure, pulmonary hypertension, cyanosis, or a Fontan/single-ventricle circulation to a center with adult or pediatric congenital heart disease expertise when procedure urgency permits. U.S. guidance has supported regionalized care for adults with congenital heart disease undergoing noncardiac surgery.PubMed+1PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf PubMedDecentralization of Care for Adults with Congenital Heart ...

Defer elective surgery for newly recognized physiologic deterioration until congenital cardiology clarifies the mechanism and perioperative plan; use echocardiography and, when needed, catheterization data to characterize ventricular performance and pulmonary hemodynamics.PubMedPubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf
Treat emergency status as an independent risk amplifier; establish lesion-specific hemodynamic goals and a postoperative location before induction rather than attempting to reconstruct anatomy during an intraoperative crisis.AHA Journals+1AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association | Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association
Anticipate difficult peripheral and central access after repeated catheterizations or surgery; review venous patency and prior access history before selecting central venous access.PubMedPubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

Features that should change perioperative location, monitoring, or staffing.AHA Journals+3AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association | Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf PubMedDecentralization of Care for Adults with Congenital Heart ...
Current finding	Why it changes the plan	Immediate planning action
Repaired simple defect without functional deterioration	Conventional anesthetic techniques may be feasible when repair is complete and physiology remains stable.PubMedPubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf	Confirm current echocardiographic status and proceed with monitoring proportional to surgical stress.PubMedPubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf
Major or severe congenital heart disease, important residual lesion, or prior complex repair	Complexity and residual physiologic burden are associated with higher perioperative risk.AHA Journals+2AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association \| Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association PubMedPerioperative Risk in Adults with Congenital Heart Disease Undergoing Non-Cardiac Surgery: Challenges and Tailored Strategies	Coordinate congenital cardiology, anesthesia, surgery, and postoperative disposition before elective surgery.PubMed+1PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf PubMedDecentralization of Care for Adults with Congenital Heart ...
Single-ventricle or Fontan physiology	Pulmonary blood flow is nontraditional and may be vulnerable to increased intrathoracic pressure and impaired venous return.AHA Journals+1AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association \| Circulation: Cardiovascular Quality and Outcomes Wolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology	Plan to preserve venous return and pulmonary blood flow; use an experienced congenital anesthesia team and monitored postoperative setting.Wolters Kluwer+1Wolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf
Pulmonary hypertension, cyanosis, or ventricular dysfunction	These conditions increase perioperative complication risk and can produce rapid hemodynamic deterioration.AHA Journals+2AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association \| Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf	Define baseline saturation and ventricular status, avoid triggers for pulmonary vascular constriction, and arrange escalation capability.AHA Journals+2AHA JournalsACC/AHA 2007 Guidelines on Perioperative ...WileyAdult congenital heart disease and anesthesia: An ...PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

Risk Stratification

Identify the lesion-specific drivers of perioperative events

Assess cardiac physiology and procedural stress together.

In a Boston Children's Hospital analysis of 3,010 patients with congenital heart disease undergoing noncardiac surgery between 2008 and 2013, cardiovascular events occurred in 11.5% and respiratory events in 4.7%. Cardiovascular events were associated with ASA physical status at least 3, emergency surgery, major or severe congenital heart disease, single-ventricle physiology, ventricular dysfunction on preoperative echocardiography, and surgical specialty.AHA Journals+1AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association | Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Use lesion complexity as a first screen but then identify the dominant active problem: residual shunt, ventricular failure, pulmonary vascular disease, obstructive lesion, rhythm/device dependence, or abnormal preload pathway. Pediatric risk frameworks have classified repaired atrial or ventricular septal defects and mild single-valve stenosis or regurgitation as lower risk; unrepaired simple lesions, repaired complex lesions, prior single-ventricle physiology, transplantation, pacemaker dependence, Wolff-Parkinson-White syndrome, and long-QT syndrome as higher-concern categories requiring individualized planning.AHA Journals+1AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association | Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Apply the 2024 ACC/AHA perioperative cardiovascular guideline to adult noncardiac-surgery decisions while retaining congenital anatomy and physiology as separate considerations; that guideline supersedes the 2014 ACC/AHA perioperative guideline.Wolters KluwerWolters Kluwer2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM... Standard adult risk tools do not replace congenital-focused review in patients with residual shunts, pulmonary hypertension, cyanosis, or palliated circulations.PubMed+1PubMedPerioperative Risk in Adults with Congenital Heart Disease Undergoing Non-Cardiac Surgery: Challenges and Tailored Strategies PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

Document baseline oxygen saturation and hemoglobin concentration in cyanotic or shunt physiology, because both inform interpretation of perioperative oxygenation and bleeding tolerance.AHA JournalsAHA Journals2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the ...
Review the latest echocardiogram for systemic and subpulmonic ventricular function, valve lesions, shunt direction, and estimated pulmonary pressures; ventricular dysfunction was a risk-associated feature in pediatric noncardiac surgery.AHA Journals+1AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association | Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association
Obtain an ECG and review arrhythmia history, implanted device dependence, and antiarrhythmic therapy in patients with prior atrial surgery, channelopathy, pacemaker dependence, or palpitations/syncope.AHA Journals+1AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association | Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association
Match monitoring and postoperative level of care to the highest-risk interaction between patient physiology and procedure, especially emergency, orthopedic, general, neurosurgical, or pulmonary procedures.AHA Journals+1AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association | Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Physiology-based preoperative branching for congenital heart disease.AHA Journals+4AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association | Circulation: Cardiovascular Quality and Outcomes AHA JournalsACC/AHA 2007 Guidelines on Perioperative ...WileyAdult congenital heart disease and anesthesia: An ...WileyError traps in patients with congenital heart disease ...PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf
Dominant problem	Preoperative discriminator	Perioperative priority
Residual or unrepaired shunt	Define shunt direction, resting saturation, ventricular loading, and susceptibility to systemic hypotension.AHA Journals+1AHA JournalsACC/AHA 2007 Guidelines on Perioperative ...PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf	Avoid hemodynamic changes that increase right-to-left shunting; promptly correct systemic hypotension and acidosis.AHA JournalsAHA JournalsACC/AHA 2007 Guidelines on Perioperative ...
Pulmonary hypertension or right ventricular dysfunction	Review ventricular function and pulmonary hemodynamics; identify hypoxemia, acidosis, or ventilatory vulnerability.AHA Journals+2AHA JournalsACC/AHA 2007 Guidelines on Perioperative ...WileyAdult congenital heart disease and anesthesia: An ...PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf	Maintain preload and right ventricular contractility while minimizing pulmonary vascular resistance.WileyWileyAdult congenital heart disease and anesthesia: An ...
Single-ventricle or Fontan circulation	Identify prior Fontan-type pathway, baseline saturation, venous congestion, effusions, ascites, and respiratory reserve.Wolters KluwerWolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology	Protect venous return and pulmonary blood flow; avoid circumstances that substantially raise intrathoracic pressure.Wolters KluwerWolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology
Arrhythmia or device dependence	Review ECG, device status, prior tachyarrhythmia, and current beta-blocker or antiarrhythmic treatment.AHA Journals+2AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association \| Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association WileyError traps in patients with congenital heart disease ...	Maintain continuity of rhythm-directed therapy when feasible and create a device-specific intraoperative plan.WileyWileyError traps in patients with congenital heart disease ...

Anesthetic Management

Translate congenital physiology into intraoperative hemodynamic goals

Choose techniques and monitoring that preserve the circulation's limiting variable.

There is no single anesthetic technique for congenital heart disease because risk arises from the interaction of defect complexity, residual physiology, and the noncardiac procedure.Wolters KluwerWolters KluwerCongenital heart diseases and anaesthesia : Indian Journal of Anaesthesia Before induction, specify the target preload, systemic vascular resistance, pulmonary vascular resistance, ventricular contractility, rhythm, ventilation strategy, vascular-access plan, rescue drugs, and triggers for transesophageal echocardiography or higher-acuity postoperative care.PubMedPubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

For pulmonary hypertension or vulnerable right ventricular physiology, maintain adequate preload, minimize pulmonary vascular resistance, and optimize right ventricular contractility.WileyWileyAdult congenital heart disease and anesthesia: An ... Avoid hypoxia and acidosis, which can worsen pulmonary pressures; in severe pulmonary hypertension with an intracardiac shunt, systemic hypotension can increase right-to-left shunting, promote acidosis, and create a self-reinforcing fall in systemic vascular resistance.AHA JournalsAHA JournalsACC/AHA 2007 Guidelines on Perioperative ...

For Fontan-type circulation, pulmonary blood flow depends on systemic venous flow reaching the lungs without passage through a subpulmonic ventricle.Wolters KluwerWolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology Coughing and increased intrathoracic pressure may impair forward flow; plan emergence and ventilation to limit major pressure-related interruption of pulmonary blood flow, particularly when cyanosis, pulmonary disease, effusions, or ascites reduce reserve.Wolters KluwerWolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology

Continue beta-blockers and pulmonary antihypertensive medications perioperatively when feasible; do not create avoidable withdrawal in patients dependent on rhythm suppression or pulmonary vasodilation.WileyWileyError traps in patients with congenital heart disease ...
Use invasive or advanced monitoring selectively for complex physiology, major surgery, hemodynamic instability, or when beat-to-beat pressure measurement and rapid blood sampling will change management; transesophageal echocardiography may help monitor adults with congenital heart disease during noncardiac surgery.PubMedPubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf
Treat central venous access as anatomy-dependent rather than routine: prior vessel catheterization, venous occlusion, shunts, and complex repairs can make line placement difficult or hazardous.PubMedPubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf
Use anxiolytic or hypnotic premedication cautiously, particularly when sedation could compromise ventilation or hemodynamics in advanced congenital physiology.PubMedPubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

Intraoperative priorities by circulation.AHA Journals+3AHA JournalsACC/AHA 2007 Guidelines on Perioperative ...WileyAdult congenital heart disease and anesthesia: An ...Wolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf
Physiology	Avoid	Protect or monitor
Pulmonary hypertension/right ventricular dysfunction	Hypoxia, acidosis, inadequate preload, and increases in pulmonary vascular resistance.AHA Journals+1AHA JournalsACC/AHA 2007 Guidelines on Perioperative ...WileyAdult congenital heart disease and anesthesia: An ...	Preload, right ventricular contractility, pulmonary vascular conditions, and rapid identification of hemodynamic compromise.Wiley+1WileyAdult congenital heart disease and anesthesia: An ...PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf
Right-to-left intracardiac shunt	Systemic hypotension and acidosis, which can worsen shunting.AHA JournalsAHA JournalsACC/AHA 2007 Guidelines on Perioperative ...	Systemic perfusion pressure, baseline and changing oxygen saturation, and acid-base status.AHA Journals+1AHA JournalsACC/AHA 2007 Guidelines on Perioperative ...AHA Journals2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the ...
Fontan circulation	Marked increases in intrathoracic pressure and conditions that impair systemic venous return.Wolters KluwerWolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology	Venous return, pulmonary blood flow, ventilation, and emergence conditions that may provoke coughing or pressure swings.Wolters KluwerWolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology
Complex repaired anatomy	Assuming standard vascular access or monitoring is feasible without reviewing prior procedures.PubMedPubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf	Prior operative and catheterization history; use anatomy-appropriate vascular access and consider transesophageal echocardiography when it will guide management.PubMedPubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

Pulmonary vascular disease and right-to-left shunting

When pulmonary vascular disease coexists with a cardiac shunt, prioritize immediate correction of systemic hypotension, hypoxemia, and acidosis because each can augment right-to-left shunting or pulmonary vasoconstriction.AHA JournalsAHA JournalsACC/AHA 2007 Guidelines on Perioperative ... Persistent instability should prompt reassessment of ventilation, volume status, ventricular function, arrhythmia, bleeding, and the need for congenital-cardiology or cardiac-anesthesia rescue support.Wiley+1WileyAdult congenital heart disease and anesthesia: An ...PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

Do not assume a postoperative low oxygen saturation is purely respiratory in a patient with shunt physiology; compare with the documented baseline and assess for a change in shunt fraction or pulmonary vascular tone.AHA Journals+1AHA JournalsACC/AHA 2007 Guidelines on Perioperative ...AHA Journals2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the ...
Avoid avoidable interruption of established pulmonary hypertension therapy during transitions between preoperative, intraoperative, and recovery settings.WileyWileyError traps in patients with congenital heart disease ...

Antibiotic prophylaxis

Do not extend infective endocarditis prophylaxis to every congenital lesion or procedure. The AHA approach cited for congenital heart disease limits prophylaxis to cardiac defects or conditions associated with high risk for fatal outcomes; verify the patient-specific indication and planned procedure rather than using diagnosis alone.PubMedPubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

Recovery and Escalation

Plan postoperative surveillance before the procedure begins

The safest recovery location depends on the anticipated failure mode.

Determine whether the patient needs routine recovery, monitored observation, or intensive care before surgery. Cardiovascular events in pediatric congenital heart disease cohorts were frequently identified by inotrope use; 99% of cardiovascular events in one analysis were associated with inotrope administration, emphasizing the need for an environment able to recognize and treat evolving hemodynamic compromise.AHA Journals+1AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association | Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Use a monitored setting for patients with single-ventricle physiology, ventricular dysfunction, pulmonary hypertension, cyanosis, significant residual lesions, major surgery, or an unstable intraoperative course. Surveillance should target hemodynamics, oxygen saturation relative to baseline, ventilation, rhythm, perfusion, and signs of worsening ventricular or pulmonary vascular failure.AHA Journals+2AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association | Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

After an unexpected saturation decline, hypotension, or difficult extubation, reassess congenital physiology rather than treating the event as routine postoperative respiratory disease. In Fontan physiology, increased intrathoracic pressure, cyanosis, pulmonary effusion, chronic lung disease, and ascites may interact to impair ventilation and cardiovascular performance.Wolters KluwerWolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology

Resume essential chronic cardiovascular therapy promptly when enteral administration is feasible, with special attention to beta-blockers and pulmonary hypertension medications.WileyWileyError traps in patients with congenital heart disease ...
Escalate persistent hypotension, acidosis, rising oxygen requirement above baseline, new arrhythmia, oliguria, congestion, or inability to liberate from positive-pressure ventilation to congenital cardiology and critical care assessment.AHA Journals+3AHA JournalsACC/AHA 2007 Guidelines on Perioperative ...WileyAdult congenital heart disease and anesthesia: An ...Wolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf
Document postoperative status against preoperative baseline saturation, hemoglobin, ventricular function, and rhythm history rather than applying a generic normal-range interpretation to cyanotic or palliated patients.AHA Journals+1AHA Journals2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the ...PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

Postoperative findings that should prompt physiology-directed reassessment.AHA Journals+3AHA JournalsACC/AHA 2007 Guidelines on Perioperative ...WileyAdult congenital heart disease and anesthesia: An ...Wolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf
Finding	Congenital physiology to reconsider	Next action
Hypotension with desaturation in shunt physiology	Increased right-to-left shunting and reduced systemic vascular resistance.AHA JournalsAHA JournalsACC/AHA 2007 Guidelines on Perioperative ...	Correct systemic hypotension, assess acid-base status and ventilation, and obtain expert congenital hemodynamic support.AHA Journals+1AHA JournalsACC/AHA 2007 Guidelines on Perioperative ...PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf
Persistent hypoxemia or ventilatory difficulty after Fontan surgery history	Impaired pulmonary blood flow from elevated intrathoracic pressure or reduced venous return; assess concurrent pulmonary disease, effusion, or ascites.Wolters KluwerWolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology	Optimize ventilation and hemodynamics, compare with baseline saturation, and escalate to congenital cardiac critical care when instability persists.Wolters Kluwer+1Wolters KluwerAbstracts From the 52nd Annual Meeting of the... : Journal of Neurosurgical Anesthesiology PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf
Hemodynamic deterioration in pulmonary hypertension/right ventricular dysfunction	Acute rise in pulmonary vascular resistance or failing right ventricular compensation.WileyWileyAdult congenital heart disease and anesthesia: An ...	Correct hypoxemia and acidosis, reassess preload and ventricular function, and continue pulmonary hypertension therapy when feasible.Wiley+1WileyAdult congenital heart disease and anesthesia: An ...WileyError traps in patients with congenital heart disease ...
New tachyarrhythmia or bradyarrhythmia	Prior atrial surgery, channelopathy, or pacemaker dependence.AHA Journals+1AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association \| Circulation: Cardiovascular Quality and Outcomes AHA JournalsPerioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association	Obtain ECG/device assessment and restore the patient-specific rhythm-management strategy.Wiley+1WileyError traps in patients with congenital heart disease ...PubMedPerioperative Management of Patients With Congenital Heart Disease - StatPearls - NCBI Bookshelf

Perioperative Management of Congenital Heart Disease