Episode 130: Adults with Congenital Heart Disease with Jochen Steppan

This podcast addresses the increasing prevalence and anesthetic management of adults with congenital heart disease. Dr. Jochen Steppan notes that while congenital cardiac anomalies affect 1% of worldwide births, improved care means more individuals are living into adulthood, often requiring non-cardiac surgeries. These patients present unique risks, combining pediatric anatomical phenotypes with geriatric comorbidities, leading to increased perioperative morbidity and mortality, especially in complex cases. The discussion emphasizes classifying congenital heart conditions by physiological phenotype—obstructive defects, pulmonary hypertension, shunting lesions, and single ventricle/Fontan physiology—to guide anesthetic strategies. For instance, managing shunting lesions involves balancing pulmonary and systemic vascular resistance, while single ventricle physiology necessitates maintaining pressure gradients for adequate pulmonary blood flow. The importance of multidisciplinary evaluation, expert centers, and tailored monitoring is underscored for optimizing patient outcomes.