Date Published: September 26, 2011
Publisher: Hindawi Publishing Corporation
Author(s): G. Fang, Y. K. Tian, W. Mei.
Recently two parturients with Eisenmenger’s syndrome underwent caesarean section at our hospital. They were managed by a multidisciplinary team during their perioperative period. The caesarean sections were uneventfully performed, one under general anaesthesia and one with epidural anaesthesia, with delivery of two newborns with satisfactory Apgar scores. One patient died in the post-partum period, and the other did well. We discuss the anaesthetic considerations in managing these high-risk patients.
During a normal pregnancy, parturients undergo dramatic physiological changes in multiple organ systems. Changes in the cardiovascular system include decreased systemic vascular resistance (SVR), increased blood volume, and increased cardiac output (CO) secondary to increased heart rate (HR) and stroke volume (SV). Cardiac disease is a major cause of maternal death, and approximately 25% of maternal cardiac deaths in the last 30 years have been due to congenital heart disease . Eisenmenger’s syndrome is classified in the high-risk category, with potentially severe cardiac and neonatal complications .
Pregnancy-induced systemic vasodilation is detrimental in parturients with Eisenmenger’s syndrome. Reduced SVR may increase right-to-left shunting and decrease pulmonary blood flow, leading to further hypoxemia with significant risks for both mother and fetus. Anaesthetic management of caesarean section in parturients with Eisenmenger’s syndrome requires balancing SVR and pulmonary vascular resistance (PVR).