Anesthetic Management of a Child with Patent Ductus Arteriosus-dependent Complex Congenital Heart Disease Undergoing Noncardiac Surgery

Abstract

Complex congenital heart diseases (CHDs) with duct-dependent pulmonary circulation pose significant challenges during anesthesia for noncardiac surgery. These patients depend on a delicate balance between systemic and pulmonary blood flow, rendering them particularly vulnerable to perioperative hemodynamic disturbances that may precipitate worsening cyanosis or acute cardiac decompensation, including heart failure. We report the anesthetic management of a rare case involving multiple unrepaired congenital cardiac anomalies undergoing noncardiac surgery. Successful perioperative management in such children requires an individualized, physiology-based anesthetic approach aimed at maintaining systemic vascular resistance, avoiding hypoxia and acidosis, and ensuring adequate analgesia. This case highlights the importance of a thorough understanding of underlying cardiac physiology, meticulous intraoperative planning, and close multidisciplinary coordination when managing high-risk patients with complex CHD.