Adult congenital heart disease

With continued advances in early treatment, babies with congenital heart disease now usually survive to adulthood. They are therefore increasingly presenting as adults for medical care to non-specialist centres. A simple classification of adult congenital heart disease (ACHD) according to complexity can help clinicians to understand the implications of the cardiac anomaly presented. Issues specific to the conduct of anaesthesia in ACHD patients include the need to maintain euvolaemia, sinus rhythm and cardiac output, and in complex situations to balance the flow between the pulmonary and systemic circulations. It should be recognized that patients with pulmonary hypertension or Eisenmenger's syndrome are at extremely high risk of death in the perioperative period, and in all but life-threatening situations they should be cared for in specialist centres. Furthermore, an understanding of the need for antibiotic and thromboprophylaxis in specific groups is essential, as are strategies to control bleeding.