Managing Pregnancy in Eisenmenger Syndrome: A Multidisciplinary Approach - A Case Report

Introduction:

● Eisenmenger syndrome is a complex congenital heart disease characterized by                 

    significant shunts .

• It poses substantial risks during pregnancy, leading to high maternal and fetal mortality rates.                                 

● This case report explores the intricate management of a pregnant patient with   

    Eisenmenger syndrome who declined termination.

Case Summary:

A 33-year-old pregnant primigravida with Eisenmenger syndrome presented to anesthesia clinic at 12 weeks of gestation for preoperative assessment.

    ●The patient had multiple cardiac interventions done in her earlier life.

    ●Termination of pregnancy was offered and refused by the couple.

    ●Her baseline maternal saturation of 75% in room air.

    ● Hospital admission at 26 weeks of gestation for close maternal and fetal          

       surveillance and maternal oxygen therapy.

    ●C-section was done  at 28 weeks of gestation which was decided after

      multiple  MDT meetings.  Dural puncture epidural anesthesia approach was adopted .

    ●Neonate faced severe complications succumbing to heart failure and

      pulmonary hypertension.

 Discussion:

● Managing pregnant patients with Eisenmenger syndrome is challenging and not standardized.

●Counseling regarding the risks and termination of pregnancy should be offered as this syndrome is poorly tolerable accompanied by the physiological changes of pregnancy.

●It is important to emphasize the need of early hospitalization, supplemental oxygen, and medications to mitigate risks.

●A delicate balance is required in anesthesia choices—general versus regional.

● DPE technique was deemed suitable to our case to avoid the hemodynamic
instability associated with positive pressure ventilation.

● Shared decision making (SDM) among obstetricians, cardiologists, and
anesthesiologists played a pivotal role in decision-making and treatment strategies.

● SDM enables a comprehensive evaluation of the patient's health and
empowers patients to actively engage in their care, aligning treatment plans with
their values and preferences.

Conclusion:

●This case underscores the critical role of multidisciplinary teams in devising anesthetic approaches for pregnant individuals with Eisenmenger syndrome.

● The inclusion of patients in decision-making processes serves as a crucial tool for
optimizing their health outcomes and overall well-being.