Preoperative Diagnostic Evaluation

Preoperative evaluation of a patient with congenital heart disease (CHD) requires an understanding of the anatomy and physiology of the lesion, associated cardiac and systemic anomalies, prior surgeries, and rhythm concerns. This chapter focuses on specific concerns for evaluating patients in each of the age groups, taking into account the alternatives of catheter-based interventions and opportunities for rhythm optimization. The recognition and evaluation of extracardiac anomalies in a neonate with CHD are critically important for assessment of cardiac surgical risk and prognosis, and appropriate counseling of families. A multifactorial hypothesis for the etiology of CHD including genetic and environmental factors has long been recognized. The value of the preoperative electrocardiogram is to identify potential rhythm or conduction abnormalities including pre-excitation, assess hypertrophy, and serve as a baseline for recognizing acute and chronic postoperative changes.