1/103. Management of labor in Eisenmenger syndrome with inhaled nitric oxide. Administration of nitric oxide by means of inhalation during the labor of a woman with Eisenmenger's syndrome caused by an atrial septal defect resulted in improved oxygenation and initial pulmonary arterial pressure. She gave birth to a live infant at 34 weeks' gestation but died of worsening pulmonary hypertension and heart failure 21 days post partum. ( info) |
2/103. Evidence of patent ductus arteriosus and right-to-left shunt by finger pulse oxymetry and Doppler signals of agitated saline in abdominal aorta. The diagnosis of patent ductus arteriosus (PDA) with right-to-left shunt in the adult by using transthoracic echocardiography (TTE) is difficult because of limited windows. We report a case of a 23-year-old woman who was referred for treatment of primary pulmonary hypertension but was found to have a PDA with a right-to-left shunt. On examination she had asymmetric hypoxia of the upper extremities on finger pulse oxymetry. Transthoracic echocardiography revealed a large right atrium and no atrial or ventricular septal wall defects. The diagnosis of PDA with Eisenmenger's syndrome was made after evidence of a right-to-left shunt was confirmed by Doppler signals of intravenous agitated saline in the abdominal aorta. This case illustrates the utility of Doppler signals from agitated saline in the abdominal aorta and finger pulse oxymetry, in addition to physical examination, in the diagnosis of PDA with right-to-left shunt. ( info) |
| The clinical cases of three patients affected respectively by Eisenmerger's syndrome, marfan syndrome, coarctation of the aorta are described. All patients belonged to NYHA class I or II. During pregnancy contact with cardiologists, anaesthetists, neonatologists was maintained and this allowed accurate management. Both pregnancy and delivery evolved without any complication and with a positive outcome for mother and newborn. ( info) |
4/103. Abundance of microembolic signals detected by transcranial doppler ultrasound in a patient with Eisenmenger's syndrome. BACKGROUND: Clinically silent circulating microemboli can be detected by transcranial Doppler sonography. CASE DESCRIPTION: We report the case of a 45-year-old man with congenital cyanotic heart disease, elevated haematocrit, low platelet count and decreased protein c and protein s activity. Before and following several haemodilutions, we performed 5 1-hour transcranial Doppler recordings from one or both middle cerebral arteries (MCAs) on different days. The number of microembolic signals per hour varied from 54 to 134. During the bilateral recording, the microemboli occurred on both sides (55 in the right and 45 in the left MCA, respectively). There was no relation to red blood cell count, platelet count, the spontaneously lowered prothrombin time or the spontaneously prolonged activated partial thromboplastin time. CONCLUSIONS: The origin of the large number of microembolic signals found in this patient remains unclear, but may be presumed in the intra-abdominal or crural venous system. ( info) |
5/103. Successful management of a pregnancy at high risk because of Eisenmenger reaction. Informed medical care, appropriate maternal and fetal monitoring, and cooperation among experienced obstetricians, anesthesists cardiologists, particularly during delivery and the early puerperium associated with psychological preparation of the mother, were the bases of the successful management of a pregnant 28-year-old woman at high risk because of the Eisenmenger reaction. ( info) |
6/103. Eisenmenger syndrome in pregnancy. maternal mortality in the presence of Eisenmenger syndrome is reported to be 30 to 50% & increases further with associated complications. A case of Eisenmenger syndrome in pregnancy where the patient progressively deteriorated postpartum & expired 3 weeks later is reported. ( info) |
7/103. Anaesthesia for caesarean section in a patient with Eisenmenger's syndrome. Eisenmenger's syndrome was originally described in 1897 and redefined by wood in 1958. This syndrome includes pulmonary hypertension with reversed or bi-directional shunt associated with septal defects or a patent ductus arteriosus. A 27-year-old G2 PO with Eisenmenger's syndrome presented to the hospital for management at 17 weeks of pregnancy. She was advised termination of pregnancy but she refused. An elective caesarean section was performed successfully under general anaesthesia uneventfully at 29 weeks due to severe intrauterine growth retardation (IUGR). Patient's postoperative complications like pulmonary thromboembolism, the advantages and disadvantages of anticoagulation are discussed. pregnancy carries substantial maternal and fetal risk for patients with pulmonary hypertension and Eisenmenger's syndrome. Although pregnancy should be discouraged in women with Eisenmenger's syndrome it can be successful. ( info) |
8/103. Failure of medicine: evolution of an atrial septal defect to an Eisenmenger syndrome. The atrial septal defect (ASD) is the most commonly diagnosed congenital defect in adults and has a prevalence of 7.5% of all congenital cardiac anomalies. Less invasive imaging techniques, especially transthoracic and transoesophageal echocardiography, provide more accurate diagnostics, resulting in earlier diagnosis and treatment. Despite these opportunities in high-tech countries, medicine may still fail in detecting initially correctable cardiac anomalies. We present a case of 41-year-old woman with an abnormal murmur at childhood that disappeared with time due to the development of an Eisenmenger syndrome. The importance of a complete haemodynamic evaluation in this patient is illustrated. ( info) |
9/103. Multiple dental extractions using general anesthesia for a patient with Down and Eisenmenger syndromes and periodontal disease. A patient with down syndrome and severe retardation and Eisenmenger syndrome sought dental treatment at the oregon health Sciences University Hospital Dental Service. Eisenmenger syndrome is a form of cyanotic congenital cardiovascular pulmonary disease. The cardiac structural abnormalities associated with Eisenmenger syndrome preclude the use of conscious sedation and predispose a patient to the development of bacterial endocarditis. A prophylactic antibiotic regimen is recommended for patients with Eisenmenger syndrome who are undergoing procedures that produce a transient bacteremia. This article reviews the appropriate measures necessary for the safe anesthetic, operative, and perioperative care of a severely compromised patient. It is based on an understanding of the pathophysiology associated with Eisenmenger syndrome. ( info) |
10/103. Bilateral central retinal vein occlusion in Eisenmenger syndrome. PURPOSE: To report a case of bilateral central retinal vein occlusion in a patient with Eisenmenger syndrome. methods: Case report. A 60-year-old woman with Eisenmenger syndrome secondary to a congenital ventricular septal defect presented with a 2-week history of decreased vision in both eyes. RESULTS: Ophthalmic examination revealed bilateral central retinal vein occlusion. Laboratory findings included hematocrit of 50.3% and pO(2) of 52 mm Hg while on O(2) 5 L/min per nasal cannula, despite having undergone phlebotomy 2 weeks earlier. CONCLUSION: Chronic hypoxia caused by Eisenmenger syndrome may result in polycythemia with resultant hyperviscosity and bilateral central retinal vein occlusion. ( info) |