The American Heart Association has given recommendations for evaluating a patient with congenital heart disease (CHD) prior to noncardiac surgery.
Patient selection: noncardiac surgery in a patient with congenital heart disease
Parameters:
(1) emergency versus elective surgery
(2) risk group for the congenital heart disease (low, moderate or high)
(3) high risk findings
High risk findings:
(1) history of Fontan procedure
(2) severe pulmonary arterial hypertension
(3) cyanotic CHD
(4) systemic ventricular dysfunction and/or residual heart failure
(5) need for anticoagulation
(6) malignant arrhythmia
General recommendations:
(1) Surgery should be performed if possible at a center with expertise in dealing with patients with congenital heart disease.
(2) Emergency surgery may need to take place without preoperative risk assessment.
(3) Preoperative testing may include ECG, chest X-ray, echocardiogram, oximetry, complete blood cell count (CBC), metabolic panel and coagulation screen.
(4) A patient with evidence of impaired functional capacity and moderate or high risk CHD should be considered for cardiopulmonary exercise testing prior to surgery.
Recommendations for high risk patient (moderate or high risk CHD group with functional impairment and/or high risk features):
(1) cardiac anesthesiology consult
(2) ICU postoperatively
(3) antibiotic prophylaxis to reduce the risk of endocarditis
(4) assessment for anticoagulation
(5) early use of inotropic support
(6) hydration
(7) central venous access
(8) arterial line
(9) inhaled nitrous oxide (NO) on standby
(10) air vigilance or air filters if cyanotic
