Síndrome de Eisenmenger na gravidez

Abstract

Eisenmenger's syndrome consists of pulmonary hypertension with a reversed or bidirectional shunt at the atrioventricular, or aortopulmonary level. Eisenmerger's syndrome in pregnancy is usually associated with high mortality rates (nearly 30-50%). Unfortunately, pulmonary hypertension is aggravated during pregnancy and often leads to an unfavorable outcome. Here, we report a successful pregnancy in a woman with Eisenmenger syndrome.

Eisenmenger Syndrome in Pregnancy

“…Once the patients develops Eisenmenger syndrome, the machinery murmur might be unaudible and the associated patent ductus arteriosus might be misdiagnosed [10] . Patients may have a low oxygen saturation [11] and polycythemia [12] . Severe complications, such as heart failure, endocarditis and thromboembolic accidents, may develop in the condition of pregnancy.…”

Eisenmenger′s syndrome in pregnancy: Use of epidural anesthesia and analgesia for elective cesarean section

“…Pulmonary hypertension in pregnancy is associated with high mortality (30%-50%);[123] hence, pregnancy is contraindicated. Whatever anesthetic technique is chosen, principle remains the same.…”

Successful management in a pregnant woman with Eisenmenger's syndrome undergoing emergency cesarean section under general anesthesia

“…However, in patients with ES, an irreversibly increased pulmonary vascular resistance restricts blood flow to the lungs. Therefore, an increased plasma volume adds burden to the already compromised right ventricle [ 3 , 4 ]. Moreover, systemic vasodilation with pre-existing pulmonary hypertension increases the right-to-left shunt, which worsens the hypoxia [ 3 , 4 ].…”

“…Therefore, an increased plasma volume adds burden to the already compromised right ventricle [ 3 , 4 ]. Moreover, systemic vasodilation with pre-existing pulmonary hypertension increases the right-to-left shunt, which worsens the hypoxia [ 3 , 4 ]. These series of changes occur in a vicious cycle of increases in the pulmonary hypertension, right ventricular strain, and right-to-left shunt [ 3 ].…”

“…An obstetrician was concerned about the postoperative bleeding. Considering that any hypovolemia could result in a sudden death in the case of our patient [ 4 ], our team decided to follow the obstetrician's suggestion.…”