title: Anesthesia in adults with congenital heart disease.
abstract: OBJECTIVE
  The current review focuses on patients with congenital heart disease (CHD) with regard to recent trends in global demographics, healthcare provision for noncardiac surgery, as well as anesthetic and perioperative care for these patients.
  
  
  RESULTS
  About 40 years after milestones of surgical innovation in CHD, the number of adults with CHD (ACHD) now surpasses those of children with CHD. This development leads to the fact that even patients with complex CHD managed for noncardiac surgery are not restricted to highly specialized centers. However, preoperative risk assessment for anesthesia in these patients is complex due to underlying cardiac morbidity and substantial CHD-associated noncardiac morbidity. In addition to clinical assessment and echocardiography, biomarker measurement may be a clinically useful tool to estimate severity of heart failure in CHD patients. The high negative predictive value of NT-proBNP makes it particularly valuable as a screening tool. Further, morbidity and mortality in ACHD patients are mainly caused by arrhythmias and therefore are also relevant for perioperative management. Adverse events and perioperative death in ACHD patients in cardiac and noncardiac surgery are frequently related to intraoperative anesthetic care.
  
  
  CONCLUSIONS
  Medical progress in treatment of CHD has shifted morbidity and mortality of these patients largely to adulthood. Future investigations including risk stratification of ACHD patients are necessary to further improve perioperative management, especially for low-risk and high-risk noncardiac management.
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Baehner
authors.forename: Richard K
authors.initials: RK
authors.lastname: Ellerkmann
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D019990:Perioperative Care / Q000379:methods*; D059035:Perioperative Period / Q000401:mortality; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology; D018570:Risk Assessment / Q000379:methods; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain