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1、NON-CARDIACSURGERYINCHILDRENWITHCONGENITALHEARTDISEASECHD8per1000livebirths½millionpatientsintheUSwithrepaired,palliatedorunoperatedCHDAdvancesinMxincreasingsurvivalTrendtoearlyrepairAnestheticmxcomplicatedbydiversityofCHDandwidespectrumofsurgeriesperformedCHDadd
2、ssignificantlytothemortalityofnon-cardiacsurgerySPECTRUMOFCHDSPECTRUMOFINTERVENTIONTruecorrectionPDA,ASD,someVSDCorrectionwithresiduaSomeVSD,CoartationoftheAortaCorrectionwithsequelaeTOF,TGAComplicationsArrhythmiasorconductionabn.fromincisionsorsuturesPalliatives
3、urgeryB-Tshunt,PAbandingCathlabinterventionsCureorpalliationISSUESTORESOLVENatureofrepairAgeanderaofrepairVentricularoutflowobstructionVentriculardysfunctionArrhythmiasandconductionabnormalitiesHypoxemiaPulmonaryHypertensionEndocarditisprophylaxisExtracardiacprob
4、lemsMonitoringNATUREOFTHEREPAIRANATOMIC–LVtoaortaRVtopulmarterycirculationinseriescyanosiscorrecteda)SimpleRecon–ASD,VSD,PDAtreatasfornormalheartb)Complex–outflowtract(TOF,AS,PS,coarct)conduitsorbaffles(PA)septumandAVvalverepairNATUREOFTHEREPAIR2.PHYSIOLOGICAL–si
5、ngleor2ventriclecircinseriescyanosisrelievedsignificantsequelaea)Twoventriclerepair-RVissystemicLVispulmonaryb)SingleventricleTA,HRHS,doubleinlet/outletventriclesVenousreturndirectlytoPAsuccess:RAtoLApressuregrad,nAVvalve,ventfnseriouspotentialproblemsAGEANDERAOF
6、REPAIRThetrendsincethe80’shasshiftedtoearlydefinitiverepair,withoutpriorpalliationAlsosincethe80’sTGAisrepairedwitharterialswitch,notatrial.VENTOUTFLOWOBSTRUCTIONLV:AS,Coarct,InterruptedAoarchfatigue,syncope,chestpain,arrhythmiaRV:TOF,PS,conduit(PA/Truncus/TGAwit
7、hPS),PVOD-conduitscalcifyandnarrow-ischemic,hypertrophiedRV-intracardiacdefectmayrelievepressureVENTRICULARDYSFUNCTIONMyocardialdysfunctioninsidiousMaynotreportsymptomsHistoryofdecreasingexercisetoleranceObjectiveevaluationusefulCAUSES:volumeoverloadpressureoverl
8、oadchronichypoxemiarec/sustainedtachycardiaARRHYTHMIASmajorimpactafterpalliationorrepairlifethreateninginabnormalheartCAUSES:damageduringsurgerychamberdilatati
