• congenital heart disease
• healthcare delivery
• pulmonary vascular disease

A consequence of the advances in paediatric cardiology and paediatric cardiac surgery is a population of patients born with congenital heart disease (CHD) that is ageing and thriving despite ever-increasing complexity of the underlying cardiac disease.1 Because of this, increased attention is now paid to an individual’s neurodevelopment to maximise quality of life through the lifespan. With efforts to normalise a patient’s daily life to the best of their abilities, congenital cardiologists are often asked by patients with CHD or their families about the safety of commercial air travel. This question is especially common in the Pacific Northwest of the USA, where our Heart Center is the tertiary referral base for a fifth of the geographic USA, and patients routinely fly commercial airlines from remote areas for clinical appointments or procedures. Thus, commercial flight is often a medical necessity in addition to any desires to travel recreationally.

Because in-flight atmospheric conditions match a pressure equivalent of approximately 8000 feet (2438 m) with a corresponding fraction of inspired oxygen (FiO₂) of 0.15, even individuals without CHD experience a decrease in their peripheral capillary oxygen saturation (SpO₂) and arterial PO₂.2 Concern is raised, therefore, that this hypoxaemic milieu may lead to clinical deterioration in patients with CHD. Due to the paucity of data in patients with CHD, most current guidelines for air travel are appropriated from studies of patients with chronic pulmonary disease.3 There are little pertinent data in paediatrics which …