Anaesthesia for a patient with Eisenmenger′s syndrome undergoing caesarean section

Abstract

Eisenmenger's syndrome is a cyanotic congenital heart disease that includes pulmonary hypertension with reversed or bidirectional shunt associated with septal defects or patent ductus arteriosus. The decreased systemic vascular resistance associated with pregnancy increases the degree of right to left shunting, thereby carrying substantial risk to both the mother and the foetus. The maternal mortality rate of pregnancy in the presence of Eisenmenger's syndrome is reported to be as high as 30–70%. We present a case of a 22-year-old primigravida with Eisenmenger's syndrome who gave birth at 37 weeks of gestation via caesarean section to a live female baby under general anaesthesia. On the third post-operative day, the patient developed tachycardia, tachypnoea, hypotension and decrease in oxygen saturation despite supplemental oxygen, clinically suspected pulmonary thromboembolism. We describe the anaesthetic management for caesarean section and its complications in a patient with Eisenmenger's syndrome. Although pregnancy should be discouraged in women with Eisenmenger's syndrome, it can be successful.

Pregnancy outcome in women with Eisenmenger’s syndrome: a case series from west China

“…Either epidural or general anesthesia has been used with successful outcomes. Gurumurthy et al reported general anesthesia in patient with ES undergoing cesarean section [19]. We hold to the same opinion as Gurumurthy’s: general anesthesia could allow for adequate control of pain and early initiation of thromboprophylaxis.…”

Postnatal diagnosis of maternal congenital heart disease: missed opportunities

“…There is no significant difference in outcome based on anaesthetic technique 9 21–26. It is suggested that women are admitted from the second trimester3 or early in the third trimester17 for bed rest and optimisation.…”

“…The management of patients with Eisenmenger's syndrome and pulmonary hypertension should focus on avoiding the cardiovascular stress of labour, and caesarean section is advised 9 12. There is no significant difference in outcome based on anaesthetic technique 9 21–26.…”

“…Patients with Eisenmenger's syndrome can present with cyanosis, clubbing, polycythaemia and heart failure. The mortality is quoted as being 30–70%,9 and women with Eisenmenger's syndrome are advised against pregnancy 2 10–12. Despite this, there are several reported cases of successful pregnancies and deliveries.…”

Anaesthetic management of a pregnant woman with preeclampsia and Eisenmenger's syndrome: Role of advanced haemodynamic monitoring

“…[ 1 ] Pregnancy induced physiological changes can worsen the Eisenmenger's physiology by causing a fall in systemic vascular resistance (SVR) increasing the right to left shunting. [ 2 3 ] We discuss the challenges we faced in managing a pre-eclamptic patient with Eisenmenger's syndrome in the perioperative period.…”