Anaes · Cardiac anaesthesia
Anaesthesia for adult congenital heart disease
Also known as ACHD noncardiac surgery · Fontan anaesthesia adult · Grown-up congenital heart GUCH
Exam-pass ACHD for noncardiac surgery: lesion classification, shunt and PVR goals, Fontan physiology, endocarditis/arrhythmia risks, and centre selection for ANZCA Final.
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Red flags
- Rising PVR in Eisenmenger or Fontan can be lethal — avoid hypoxia, hypercarbia, acidosis, high mean airway pressure without thought.
- Air filters and de-airing matter with right-to-left shunt risk.
- Do not treat Fontan like a normal two-ventricle circulation.
- Complex ACHD needs specialist centre and cardiology input.
- Paradoxical embolus risk with residual shunts.
Meet the patient
A 28-year-old with a Fontan circulation for hypoplastic left heart syndrome needs a laparoscopic appendicectomy on your emergency list tonight. The registrar wants to "keep them warm and give fluids." That generic plan will kill this patient — a Fontan has no subpulmonary pump, and high mean airway pressure from pneumoperitoneum plus laparoscopic tidal volumes will strangle passive pulmonary blood flow (Fontan review scope).[2]
The single question that frames every ACHD case: can you draw the circuit? If you cannot draw where the blood goes, you are not ready to anaesthetise complex congenital disease — and you should not be doing elective major ACHD surgery on a district list without specialist support.[3]
References3ShowHide
- [1]Maxwell BG, Wong JK, Kin C, Lobato RL Perioperative outcomes of major noncardiac surgery in adults with congenital heart disease. Anesthesiology, 2013.PMID 23907357
- [2]McNamara JR, McMahon A, Griffin M Perioperative Management of the Fontan Patient for Cardiac and Noncardiac Surgery. J Cardiothorac Vasc Anesth, 2022.PMID 34023201
- [3]Baehner T, Ellerkmann RK Anesthesia in adults with congenital heart disease. Curr Opin Anaesthesiol, 2017.PMID 28306681