Anesthetic management of a pregnant patient with Eisenmenger’s syndrome: A case report

Abstract

BACKGROUND

Eisenmenger’s syndrome (ES) is a rare complication of congenital heart disease that includes pulmonary artery hypertension and reversed or bidirectional shunts. The mortality rate of pregnant women with ES is 30%-70% due to pathophysiological deterioration. Successful perioperative management of a pregnant patient with ES is a challenge for anesthesiologists.

CASE SUMMARY

A 38-year-old pregnant woman was admitted to the cardiology department of our hospital at 22 wk of gestation with complaints of chest tightness and shortness of breath for 3 wk. Transthoracic echocardiography revealed a bidirectional shunt between the descending aorta and pulmonary artery after interventional closure of the patent ductus arteriosus and severe pulmonary hypertension. ES in pregnancy was our primary suspicion. The patient elected to terminate the pregnancy under adequate preoperative preparation, rigorous intraoperative monitoring, and perfect epidural anesthesia. She was discharged successfully on postoperative day 16.

CONCLUSION

Our experience in this case suggests that successful outcomes are possible in pregnant patients with ES for termination of pregnancy under epidural anesthesia and intensive monitoring.

Keywords: Eisenmenger’s syndrome; Pulmonary artery hypertension; Pregnancy; Monitoring; Epidural anesthesia; Case report

Core Tip: Eisenmenger’s syndrome (ES) is a rare complication of congenital heart disease, with a high maternal mortality of 30%-70%. We present a rare case of a pregnant woman with ES after cardiac surgery. The patient elected to terminate the pregnancy under adequate preoperative preparation, rigorous intraoperative monitoring, and perfect epidural anesthesia. Our experience in this case suggests that successful outcomes are possible in pregnant patients with ES for termination of pregnancy under epidural anesthesia and intensive monitoring.