Critical Care of the Adult With Congenital Heart Disease

Advances in the treatment of congenital heart disease (CHD) have led to dramatic improvements in survival for individuals with CHD. While adults with CHD represent a small percentage of admissions to the intensive care unit (ICU), the critical care needs of this population will grow as this population ages and develops increasingly complex cardiac and noncardiac conditions. Adults with CHD require special care in the ICU because of both their unique cardiovascular conditions and the multi-organ dysfunction that often accompanies their cardiac pathophysiology. This review aims to summarize the current epidemiology of critical care for adults with CHD, describe key physiologic and management considerations in caring for adults with highly complex CHD (eg, Fontan circulation, systemic right ventricle, and Eisenmenger syndrome), identify cardiac and noncardiac risk factors for adverse outcomes following admission to the ICU, and define key research and educational priorities for the future care of this vulnerable population.