Key result
Pregnancy in women with Eisenmenger syndrome carries a high maternal mortality rate of 30-50%, and epidural anesthesia is preferred for delivery to minimize hemodynamic risks.
Why the study?
Eisenmenger's syndrome in pregnancy carries a 30%-70% mortality rate, making perioperative anesthetic management challenging.
Pregnancy in women with Eisenmenger syndrome carries a high maternal mortality risk (30-50%), necessitating avoidance of pregnancy or meticulous multidisciplinary management with epidural anesthesia if delivery or termination occurs.
Supports individualized perioperative strategies in Eisenmenger syndrome pregnancies; leaves open need for larger studies before guiding practice.
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.
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Zhang et al. (2023) conducted a review in Eisenmenger syndrome in pregnancy. Epidural anesthesia and multidisciplinary management was evaluated on Maternal mortality. Pregnancy in women with Eisenmenger syndrome carries a high maternal mortality rate of 30-50%, and epidural anesthesia is preferred for delivery to minimize hemodynamic risks.
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