Anesthetic management of a pregnant patient with Eisenmenger's syndrome: A case report.
Case report
Eisenmenger’s syndrome
Epidural anesthesia
Monitoring
Pregnancy
Pulmonary artery hypertension
Journal
World journal of clinical cases
ISSN: 2307-8960
Titre abrégé: World J Clin Cases
Pays: United States
ID NLM: 101618806
Informations de publication
Date de publication:
26 Sep 2023
26 Sep 2023
Historique:
received:
24
06
2023
revised:
08
08
2023
accepted:
17
08
2023
medline:
30
10
2023
pubmed:
30
10
2023
entrez:
30
10
2023
Statut:
ppublish
Résumé
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. 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. 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.
Sections du résumé
BACKGROUND
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
METHODS
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
CONCLUSIONS
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.
Identifiants
pubmed: 37900253
doi: 10.12998/wjcc.v11.i27.6597
pmc: PMC10600995
doi:
Types de publication
Case Reports
Langues
eng
Pagination
6597-6602Informations de copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Références
Ann Card Anaesth. 2020 Jan-Mar;23(1):95-97
pubmed: 31929258
Braz J Cardiovasc Surg. 2016 Jul-Sep;31(4):325-329
pubmed: 27849306
Br J Anaesth. 2006 Sep;97(3):329-32
pubmed: 16798771
J Cardiothorac Vasc Anesth. 2020 Oct;34(10):2813-2822
pubmed: 32381307
J Pregnancy. 2021 Sep 27;2021:3248850
pubmed: 34616573
J Clin Med. 2021 Jul 22;10(15):
pubmed: 34362015
Expert Rev Cardiovasc Ther. 2023 Jul-Dec;21(8):587-599
pubmed: 37470417
Eur Heart J. 2018 Sep 7;39(34):3165-3241
pubmed: 30165544
Medicina (Kaunas). 2022 Mar 25;58(4):
pubmed: 35454315
Taiwan J Obstet Gynecol. 2019 Mar;58(2):183-187
pubmed: 30910135
Pulm Circ. 2019 Nov 18;9(4):2045894019884516
pubmed: 31798834
Indian J Anaesth. 2012 May;56(3):291-4
pubmed: 22923831
J Clin Anesth. 2014 Jun;26(4):286-93
pubmed: 24908593
J Anaesthesiol Clin Pharmacol. 2014 Jul;30(3):425-6
pubmed: 25190960