Paediatric pulmonary hypertension due to congenital heart disease in non-cardiac surgery: Anaesthetic implications

Abstract

Paediatric patients with pulmonary hypertension associated with Congenital Heart Disease (PH-CHD) are frequently encountered in non-cardiac surgical settings. Although the pharmacological and surgical management of the underlying CHD in the group has improved yet its management remains challenging due to associated high morbidity and mortality. The dilemma prevails more so because of the dearth of adequate literature describing its pathophysiology and management in non-cardiac surgical settings. There are no specific guidelines pertaining to paediatric PH-CHD care, and the precepts have been extrapolated from adult studies and guidelines. This review article intends to apprise the pathophysiology of PH-CHD, its management, and its perioperative care with special emphasis on pulmonary vascular hypertensive crisis in these patients posted for non-cardiac procedures.