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

Abstract

We describe a case of a pregnant patient with a large ventricular septal defect (VSD) and pulmonary artery hypertension, presented to the hospital and underwent elective cesarean section under epidural anesthesia and postoperative analgesia. The procedure was uneventful till the patient was discharged on 10th day.

Eisenmenger Syndrome in Pregnancy

“…Cesarean section should be avoided due to the potentially fatal decrease of circulating blood volume in patients with Eisenmenger syndrome; while vaginal delivery appears to be safer [23] . Epidural anesthesia reduces the chance of precipitous hemodynamic changes, and is safe to administer epidural anesthesia to patients with Eisenmenger syndrome [24] . Epidural or intrathecal morphine sulphate can be devoid of effect on systemic blood pressure and represents the best approach to anesthetic management in such patients [16] .…”

“…Mishra et al [24] reported antenatally irregular treatment with tablet sildenafil 25 mg twice a day in pregnant patients with Eisenmenger syndrome. Lacassie et al [30] reported a woman with severe PAH due to Eisenmenger syndrome treated during pregnancy, delivery and postpartum with sildenafil 150 mg/day along with L-arginine 3 g/day and facemask nitric oxide 64 ppm, leading to a significant reduction of PAH and PVR and clinical improvement within short time.…”

Paciente con síndrome de Eisenmenger complicado por sangrado digestivo alto

“…La disminución grave del gasto cardíaco unido a la resistencia vascular sistémica (RVS) tiene la potencialidad de aumentar la derivación de sangre de derecha a izquierda, con la posibilidad de inducir al colapso circulatorio y la insuficiencia cardíaca; lo que constituyó la injuria clínica que se manifestó en el paciente en cuestión. (12,13) La insuficiencia cardíaca produce una disminución del flujo sanguíneo hepático con la consecuente afectación del aporte de oxígeno, ocasionando la necrosis de los hepatocitos del área 3. (14) A su vez, la hipoxia estimula el incremento de la presión venosa capilar, el desarrollo de fibrosis y la hipertensión portal, los que junto a la disminución de la síntesis proteica y los factores de coagulación provocan un cuadro de ascitis y trastornos hemorrágicos.…”

Segmental epidural anesthesia for cesarean section in a parturient with uncorrected Taussig–Bing anomaly with transposition of the great arteries physiology

“…Such patients have complex pathophysiology, which can lead to unstable haemodynamics, arrhythmias and cardiac arrest under anesthesia. This is a rare case of a parturient with Eisenmenger syndrome[ 1 2 3 ] due to Taussig–Bing anomaly[ 4 ] with transposition of the great arteries (TGA) physiology[ 4 5 ] (double-outlet right ventricle (DORV) with sub-pulmonic ventricular septal defect (VSD) presenting for elective cesarean section for oligohydramnios and intrauterine growth retardation (IUGR). We report the successful management of this patient under segmental epidural anesthesia.…”