1/13. An autopsied case of Eisenmenger syndrome complicated by recurrent thromboembolic phenomena in postpartal period.dyspnea, back pain, edema, and cyanosis developed suddenly in a 23-year-old woman during the last trimester of her first pregnancy. Although she had been noticed to have the enlarged heart and exertional shortness of breath to a slight degree, she had been apparently in good condition without any significant heart murmurs. Clinically, recurrent episodes of disseminated intravascular coagulation, including pulmonary thrombosis, were thought to be superimposed to Eisenmenger syndrome associated with toxemia of pregnancy. Anticoagulant and fibrinolytic treatments were tried, but their effectiveness was limited by hemorrhagic diathesis. She died of respiratory and circulatory failure after delivery of a moribund baby. autopsy revealed eisenmenger complex (a defect in the membranous portion of the interventricular septum and pulmonary vascular disease) and many fresh hemmorrhages in both lungs with a lot of new and organized thrombi. Fresh thrombi were also seen in the heart, the pancreas and the kidneys. The high peripartal mortality in Eisenmenger syndrome could be attributed to pulmonary thrombosis, which may be related to DIC, as well as to peripartal changes in circulatory function.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/13. heart-lung transplantation in korea.heart-lung transplantation is an effective treatment for patients with various forms of congenital heart disease or pulmonary hypertension. Since the first heart-lung transplantation in 1997, five transplants have been performed in korea. Three cases were performed in 1997, one in 1998, and the latest one in 2002. The preoperative diagnoses were complex congenital heart disease (CHD) in 2, and CHD with Eisenmenger's syndrome in 3. In this paper, we report five cases of heart-lung transplantation performed in korea, and include a review of the relevant literature.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
3/13. Gas exchange detection of right-to-left shunt in dyspneic patients: report of three cases.We evaluated three patients with undiagnosed complaints of progressive dyspnea. Based on gas-exchange findings as the initial diagnostic tool, the high ventilatory equivalents for CO2, low sustained end-tidal PCO2, hypoxemia, and central cardiovascular dysfunction during cardiopulmonary exercise testing (CPET) suggested that each had significant pulmonary vasculopathy with right-to-left shunting. The diagnoses of Osler-Rendu-Weber syndrome, ventricular septal defect with Eisenmenger's complex, and hepatopulmonary syndrome were later confirmed by pulmonary angiography, cardiac catheterization, and contrast enhanced echocardiography respectively. We suggest that CPET is an appropriate noninvasive tool to begin and guide the evaluation of undiagnosed dyspnea.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
4/13. Opitz trigonocephaly syndrome.We report on a patient with Opitz trigonocephaly syndrome. The girl was the first-born child of consanguineous parents and had trigonocephaly, apparent hypertelorism, upslanted palpebral fissures, strabismus, small nose with broad root, abnormally modeled ears, high palate, short neck with loose skin, polysyndactyly, and prominent clitoris and labia majora. In addition, a complex cardiovascular defect (Eisenmenger disease) was observed. The patient was mentally retarded.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
5/13. heart-lung transplantation: the initial arizona experience.Since November 1985, cardiopulmonary transplantation has been performed at the University of arizona heart transplant program. Seven patients, five women and two men, have undergone heart-lung transplantation. Five patients had primary pulmonary hypertension, and two patients had Eisenmenger's complex. The mean age was 31 years (range, 17 to 43 years). Average follow-up was 15 months (range, 3 to 34 months), with a total of 115 patient-months. There have been no operative or late deaths. immunosuppression consisted of rabbit antithymocyte globulin, cyclosporine (Cyclosporin A), azathioprine, methylprednisolone, and prednisone. Our first five patients were aggressively diagnosed and treated for rejection by endomyocardial biopsy, with each patient having one or several treatments for acute rejection. These five patients had one or several episodes of severe infection, particularly cytomegalovirus. In our last two patients we omitted routine heart biopsies. Only those rejection episodes diagnosed by chest x-ray films are considered significant. Our last two patients have not been treated for acute rejection and have had no infections. Presently our immunologic surveillance consists only of careful clinical examination and frequent chest x-ray films. Any changes in the patient's condition are aggressively investigated, searching for infection or rejection. Two patients have been used as domino donors of their native heart.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
6/13. Giant right atrial thrombus in noonan syndrome combined with Eisenmenger's complex.A 54-year-old woman with the noonan syndrome was admitted with congestive heart failure and a giant right atrial thrombus with atrial septal defect detected by two-dimensional echocardiography. The thrombus vanished on oral anticoagulant therapy with warfarin. The thrombus is considered to result from hemostasis in the right atrium due to congestive heart failure and to her specific skeletal characteristics. This report describes the first case of noonan syndrome with right atrial thrombus.- - - - - - - - - - ranking = 4keywords = complex (Clic here for more details about this article) |
7/13. Superselective angiography with digital subtraction and embolization of a maxillary hemangioma in a patient with Eisenmenger's syndrome.Central maxillofacial hemangiomas can represent diagnostic and therapeutic problems. The concurrent existence of Eisenmenger's complex in the presented case added an anesthetic challenge. The development of superselective arterial catheterization and digital subtraction angiography has been instrumental in improving the ability of clinicians to diagnose and effectively manage vascular lesions, especially in the maxillofacial region. Embolization remains an excellent adjunctive therapy for vascular processes.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
8/13. Maternal and neonatal death associated with Eisenmenger's syndrome.pregnancy in patients with Eisenmenger's syndrome is known to be associated with a high incidence of maternal and perinatal death. Complications can occur before and during parturition but are most hazardous in the early postpartum period. If the exact causes of maternal death remain in most instances unknown, hypovolemia with augmented pulmonary to systemic shunt, thromboembolism and cardiac arrythmias are often mentioned as the primary causes of mortality. We report the unsuccessful management of a pregnant patient with Eisenmenger's disease despite all possible precautions as reported in the literature had been taken. We discuss these precautions and more specifically the type of anesthesia that is best given, the prophylactic methods of anticoagulation and the benefit of monitoring techniques in the management of such complex pathologies.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
9/13. Anaesthesia for a patient with Down's syndrome and Eisenmenger's complex.A patient with Down's syndrome and Eisenmenger's complex presented for orthopaedic surgery on the elbow under general anaesthesia. During pre-oxygenation, in order to prevent a subsequent fall in systemic vascular resistance, metaraminol 1 mg was administered intravenously. The patient immediately developed bradycardia, mild hypertension and became deeply cyanosed. His condition rapidly improved after atropine 0.6 mg was given intravenously. Following induction of anaesthesia with thiopentone and tracheal intubation facilitated by suxamethonium, anaesthesia was maintained by mechanical ventilation of the lungs with nitrous oxide and oxygen (40%) with intravenous increments of fentanyl for analgesia and pancuronium for muscle relaxation; residual neuromuscular blockade was reversed with neostigmine. The patient made an eventful recovery. Although general anaesthesia is tolerated by patients with Eisenmenger's complex, powerful vasoactive drugs should not be administered unless specifically indicated.- - - - - - - - - - ranking = 6keywords = complex (Clic here for more details about this article) |
10/13. eisenmenger complex and pregnancy.eisenmenger complex is a congenital heart disease, which causes considerable maternal mortality. Data from the literature suggest a maternal mortality of 26%, with an infant survival of 57%. We describe a successful pregnancy and vaginal delivery of a woman with eisenmenger complex and discuss the problems associated with eisenmenger complex and pregnancy.- - - - - - - - - - ranking = 7keywords = complex (Clic here for more details about this article) |
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