Synopsis Most data regarding cardiac and obstetric risk to women with CHD during pregnancy derive from ret- rospective case series.S3.13.1-2 S3.13.1-5,S3.13.1-8,S3.13.1-10,S3.13.1-12, Many women with CHD considering pregnancy may have received inconsistent guidance regarding pregnancy risks.S3.13.1-21 Several risk scores have been developed to risk-stratify women with heart disease desiring pregnancy,S3.13.1-2,S3.13.1-7 and a prospective Table 11. ACHD Management Issues for Noncardiac Surgery Clarify CHD diagnosis Clarify prior procedures, residua, sequelae, and current status, including ACHD AP classification Be aware that history obtained from only the patient and family may be faulty or incomplete Obtain and review old records to ensure accurate understanding of past procedures and clinical course Complete additional investigations required to define ACHD AP classification Develop management strategies to minimize risk and optimize outcome Factors associated with increased risk of perioperative morbidity and : Cyanosis Congestive HF Poor general health Younger age Pulmonary hypertension Operations on the respiratory and nervous systems Complex CHD Urgent/emergency procedures Issues to consider: Endocarditis prophylaxis Complications related to underlying hemodynamics Abnormal venous and/or arterial anatomy affecting venous and arterial access Persistent shunts Valvular disease Arrhythmias, including bradyarrhythmias Erythrocytosis Pulmonary vascular disease Meticulous line care (also consider air filters for intravenous lines) to reduce risk of paradoxic embolus in patients who are cyanotic because of right-to-left shunts Adjustment of anticoagulant volume in tubes for some blood work in cyanotic patients Prevention of venous thrombosis Monitoring of renal and liver function Periprocedure anticoagulation Possible need for nonconventional drug dosing Increased prevalence of hepatitis C infection because of prior procedures and remote blood transfusions Developmental disability ACHD indicates adult congenital heart disease; AP, anatomic and physiological; CHD, congenital heart disease; and HF, heart failure. 