Epidural Anesthesia for Cesarean Section in a Parturient with Eisenmenger's Syndrome

Management of cardiac arrest in a parturient with Eisenmenger's syndrome and complete atrioventricular block during Cesarean section: a case report

“…In our case, the patient had a bidirectional shunt with a left-to-right shunt dominant state. Therefore, she did not show profound hypoxemia as described in other reports [ 2 3 4 5 ]. An excessive decrease in PVR compared to SVR causes temporary high oxygen saturation in case of bidirectional shunt, but can eventually result in decreased systemic perfusion leading to systemic hypotension and acidosis.…”

“…Congestive heart failure followed by pregnancy is the most common cause of death in patients with Eisenmenger's syndrome. In many reports, cardiac failures occurred shortly after the delivery of the fetus and blood loss [ 2 3 4 ], which caused hypovolemia, decrease in SVR, increase in PVR, and severe hypoxemia: were usually treated with volume replacement, vasopressor, and NO inhalation. However, this patient developed sudden VT immediately after the incision and then progressed to VF and returned to ROSC after delivery.…”

“…Patients with Eisenmenger's syndrome are advised to avoid the pregnancy due to high maternal and fetal mortality [ 1 ]. There are several case reports on anesthetic management of patients with Eisenmenger's syndrome during Cesarean section [ 2 3 4 ]. However, the patient in this case was combined with complete atrioventricular block (AVB), which resulted in cardiac arrest before the delivery of the baby.…”