Management of Eisenmenger Syndrome in Pregnancy With Sildenafil and l-arginine

Lacassie, Héctor J.; Germaín, A; Valdés, Gloría; Fernández, María Soledad; Allamand, F; Lopez, Hector L.

doi:10.1097/01.aog.0000125148.82698.65

Cited by 91 publications

(56 citation statements)

References 7 publications

(6 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Two of the 3 mothers and all 3 babies survived. One study shows that concomitant use of sildenafil and L-arginine for the management of pulmonary hypertension in pregnancy, combined with multidisciplinary care, permitted a good outcome for the mother and her infant [5]. Several studies done with heparin and vasodilators for the management of pregnancy with ES, revealed mixed response.…”

Section: Discussionmentioning

confidence: 99%

Successful Pregnancy Outcome with Eisenmenger Syndrome

Mukhopadhyav

Bhattacharya

Begum

2012

J Obstet Gynecol India

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Successful Pregnancy Outcome with Eisenmenger Syndrome

Mukhopadhyav

Bhattacharya

Begum

2012

J Obstet Gynecol India

View full text Add to dashboard Cite

“…6 Currently, efficacy of sildenafil monotherapy in patients with PAH/CHD requires further studies. 1 …”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes in patients with severe pulmonary hypertension and Eisenmenger syndrome treated with sildenafil monotherapy

2014

View full text Add to dashboard Cite

Pregnancy outcomes in patients with pulmonary arterial hypertension have not been documented in our local setting. In our institution, access to therapies like nitric oxide, inhaled prostacyclin and iloprost is limited. We describe two such women given sildenafil monotherapy between April and May 2011. Both had an atrial septal defect complicated by Eisenmenger syndrome. Both survived -one after elective Caesarean section for malpresentation (breech) under general anaesthesia, the other after an assisted vaginal delivery. In addition to oral sildenafil, both received oxygen supplementation. To date, there have been three reported cases of pulmonary arterial hypertension in pregnancy treated with sildenafil in combination with another drug. Our two cases demonstrate that treatment for pulmonary arterial hypertension using sildenafil as monotherapy may allow stabilization of the maternal condition and improve clinical outcomes for both mother and baby. However, pregnancy is still discouraged in women with pulmonary arterial hypertension. Keywords High-risk pregnancy, complications Case reportsCase 1 I.D., a 33-year-old woman with known atrial septal defect (ASD) was admitted to our institution at 34 weeks' gestation in her second pregnancy following the onset of uterine contractions. She gave a history of cyanosis when crying during childhood. During her first pregnancy six years prior, she developed exertional dyspnoea and although she delivered at term, there was a neonatal death on day seven, allegedly due to congenital heart disease (CHD).In this second pregnancy she again described exertional dyspnoea from 16 weeks but the patient had not sought medical advice until the admission.On examination, there was digital clubbing, a grade 3/6 systolic murmur audible in the second to fourth intercostal space at the right parasternal border, a split second heart sound, with a palpable pulmonary component, a right ventricular heave and clear breath sounds. Oxygen saturation on room air ranged from 78% to 81%.Echocardiography confirmed a 1.3 cm ASD, with pulmonary artery pressure (PAP) 122 mmHg (Figure 1). Oxygen support via face mask at 10 l/min improved the saturation to between 81% and 89%. She was commenced on sildenafil 50 mg 8 hourly, together with nifedipine 10 mg every 4 h to inhibit the premature labour. The nifedipine was reduced after 48 h to 10 mg every 6 h and discontinued after 72 h upon cessation of uterine contractions. Four doses of dexamethasone 6 mg IM were administered to improve foetal lung maturity. She underwent elective lower segment Caesarean section under general anaesthesia for malpresentation (breech) as on the fourth hospital day delivering a live baby (1.6 kg) APGAR 9, 9, by elective. At that time bilateral tubal ligation was performed at operation. The patient was extubated after delivery. Oxygen saturations improved to between 89% and 92% on oxygen support 2-4 l/min via nasal cannulae. She was discharged on the 15th hospital day -although tolerating room air, she was advised to con...

show abstract

“…Most authors reported positive outcomes with the use of epoprostenol [16][17][18][19][20]. Less data is available for nitric oxide [21], sildenafil [22,23], iloprost [24], and nebulized iloprost combined with epoprostenol [16,25]. A recent study has shown that 52% of pregnant women with CHD-PAH received PAH-specific therapy [7].…”

Section: Specific Therapies For Pulmonary Arterial Hypertension In Prmentioning

confidence: 99%

Pregnant woman with Eisenmenger’s syndrome (RCD code: VII-II-1A.4d)

Kopeć¹,

Leśniak‐Sobelga²,

Kaźnica-Wiatr³

et al. 2013

Journal of Rare Cardiovascular Diseases

View full text Add to dashboard Cite

Pregnancy in women with pulmonary arterial hypertension due to congenital heart disease is associated with significant morbidity and mortality both in the mother and fetus. We report a case of a 25-year-old woman with Eisenmenger's syndrome who got pregnant when treated with bosentan. Bosentan was changed to sildenafil. During the course of pregnancy she developed ischemic stroke. She delivered in the 33 week of gestation. We present our treatment approach and review the current literature on pregnany in pulmonary arterial hypertension. JRCD 2013; 1 (3): 113-117

show abstract

Management of Eisenmenger Syndrome in Pregnancy With Sildenafil and l-arginine

Abstract: The concomitant use of sildenafil and L-arginine for the management of pulmonary hypertension in pregnancy, combined with multidisciplinary care, permitted a good outcome for the mother and her infant.

Cited by 91 publications

References 7 publications

Successful Pregnancy Outcome with Eisenmenger Syndrome

Successful Pregnancy Outcome with Eisenmenger Syndrome

Pregnancy outcomes in patients with severe pulmonary hypertension and Eisenmenger syndrome treated with sildenafil monotherapy

Pregnant woman with Eisenmenger’s syndrome (RCD code: VII-II-1A.4d)

Contact Info

Product

Resources

About