ABSTRACT
Children with difficult circulations often present for noncardiac surgery. The incidence of congenital heart disease is increasing and affects 1 in 145 children in the UK [1]. Advances in diagnosis, surgical and medical management have improved survival. Previously only one in five children with complex cardiac disease survived into adulthood and now the figure is well over 80 per cent [2]. It is therefore increasingly likely that a paediatric anaesthetist will be faced with a child with heart disease.
