Anesthesic Management in Pregnant Woman with Eisenmenger Syndrome

Abstract

The mortality rate in pregnant woman with cardiovascular disease is high.1 Eisenmenger syndrome is a congenital heart disease with a shunt abnormality between the systemic and pulmonary circulation where pulmonary hypertension occurs with right to left shunt at the level of the atria, ventricles or aortopulmonary arteries.2 Patients with Eisenmenger syndrome have a mortality rate up to 56% .1 A 29 years old woman, Gravida 28-29 weeks with a history of congenital heart disease Atrial Septal Defect (ASD) Secundum 27mm-35mm, moderate tricuspid regurgitation, severe pulmonary hypertension with MPAP 78mmHg, ejection fraction (EF) 88%, by bidirectional shunt with Eisenmenger syndrome. The patient underwent elective cesarean section under general anesthesia using Ketamine, Midazolam and Atracurium. The duration of surgery is about 1 hours with stable hemodynamics, EtCO2 within normal limits and no desaturation with a total bleeding of 350 cc. A baby boy was born with a weight range of 1100gr with an APGAR Score of 6/8. Extubation is done by deep extubation. For postoperative, the patient was transferred to the CICU for 3 days for hemodynamic monitoring and moved to the ward for 1 day of treatment and the patient went home. Pregnancy with Eisenmenger syndrome has a high mortality rate. Multidisciplinary team management is required in both elective surgery and the emergency department. Both general and regional anesthesia have their advantages and disadvantages. The principle of anesthesia management is to maintain the balance of the PVR and SVR so that there is no right to left shunt that causes death.
 
 Key words: cesarean section, congenital heart disease, Eisenmenger syndrome