Non cardiac surgery in children with congenital heart disease
Children with congenital heart disease (CHD) sometimes necessitate surgical treatment for non cardiac problems. Actually, children with CHD are more likely to necessitate surgery for non cardiac problems than children with no cardiac problems. This is due to the fact that not infrequently irregularity in multiple systems can be present at the same time.
In the practice of a paediatric cardiologist, it is quite a general occurrence to be asked to assess a child who requires non cardiac surgery, to ensure that the risks of the operation and the sedation/anesthesia required do not pose too high a risk and to give advice on the clinical management during the process.
Common reasons for referral to a paediatric cardiologist are:
- Surgery for genital-urinary problems.
- Dental problems which necessitate a general anesthetic (child to be put to sleep with medications) for treatment.
- General surgery for abdominal problems which can be planned or emergency based.
- General anesthetic for diagnostic procedures (MRI scans, bronchoscope and other scans).
Children had simple, moderate or severe CHD. The mortality rate during non cardiac surgery was much higher in children with moderate (3.9%) or severe CHD (8.2%) than in matched children with no CHD. Children with easy CHD had a risk of non cardiac surgery which was like to that of children with no CHD.
Data show very visibly that children with moderate or significant CHD are at higher risk of death from non cardiac surgical measures and careful assessment and identification of these children is critical. Further research is required to establish which the best environment for the surgical procedures is and to define multidisciplinary management pathways for the administration of these children.
Children with congenital heart disease (CHD) who were once considered inoperable are increasingly living into adulthood with enhanced quality of life. By some accounts, there are now more adults than children living with CHD. This turning point reflects decades of improvement across multiple specialties. Because of these advances in pediatric cardiac care, there is an increasing population of patients presenting for surgical, radiological, obstetric, and a variety of other invasive events requiring anesthesia, bringing with them the whole spectrum of CHD along with its exclusive challenges and chance.
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