11/29. Management of Eisenmenger syndrome in pregnancy with sildenafil and L-arginine.BACKGROUND: Eisenmenger syndrome in pregnancy may be a life-threatening disease despite recent additions to the treatment options. CASE: We present a woman with severe pulmonary hypertension due to Eisenmenger syndrome treated during pregnancy and delivery and postpartum with L-arginine and sildenafil to enhance the nitric oxide pathway. This combination was associated with significant improvement in the mother's clinical and hemodynamic condition and fetal well-being. CONCLUSION: The concomitant use of sildenafil and L-arginine for the management of pulmonary hypertension in pregnancy, combined with multidisciplinary care, permitted a good outcome for the mother and her infant.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
12/29. Peripartum cardiomyopathy with recovery in a patient with coincidental Eisenmenger ventricular septal defect.Severe pulmonary vascular disease was found during pregnancy in a 31 year old woman with a large ventricular septal defect. Three months after delivery peripartum cardiomyopathy with severe biventricular failure developed. This was a chance association. Recovery of ventricular function was slow but was complete two years later. There was no advance in the pulmonary vascular disease.- - - - - - - - - - ranking = 0.14285714285714keywords = pregnancy (Clic here for more details about this article) |
13/29. Continuous spinal anesthesia and postoperative analgesia for elective cesarean section in a parturient with Eisenmenger's syndrome.We describe the use of continuous spinal anesthesia (CSA) for an elective cesarean section in a 29-year-old parturient with Eisenmenger's syndrome at 30 weeks of gestation. It is essential in patients with Eisenmenger's syndrome to prevent significant increases in right-to-left shunt following the reduction in systemic vascular resistance. In this case, the patient hoped to be awake during the operation because of her fear of death. We therefore applied CSA to this patient because single-shot spinal anesthesia and epidural anesthesia might cause sudden cardiovascular depression. In fact, sudden cardiovascular changes were avoided by the titration of local anesthetics and the operation was uneventful, although prompt treatment of hypotension was essential and adjustment of the anesthetic levels was difficult. Postoperative patient-controlled spinal analgesia provided satisfactory pain relief with hemodynamic stability and no significant side effects. However, thorough experience with the requisite techniques is critical in CSA because of the technical difficulty of the procedure, and anesthesiologists must gain such experience in less-demanding cases before attempting to administer it in patients presenting extreme challenges as described in this case report.- - - - - - - - - - ranking = 0.0137912723893keywords = gestation (Clic here for more details about this article) |
14/29. General anaesthesia for emergency caesarian section in a patient with Eisenmenger's syndrome and pre-eclampsia.Pregnancy is poorly tolerated in patients with Eisenmenger syndrome (ES) with maternal mortality of 30-50%. Physiological changes of pregnancy decreases systemic vascular resistance that further aggravates the bi-directional or right to left shunt associated with ES. When it occurs with eclampsia, the morbidity and mortality are even higher. We report a case of 30 weeks pregnant woman with ES, who underwent emergency caesarian section because of pre-eclampsia. The intra-operative course was uneventful but she died on the second post-operative day. Post-operatively she was managed by the cardiologist in the coronary care unit. The probable cause being that she was over transfused, as the fluid status was not assessed by any invasive monitoring (like CVP). It was concluded that patients should be monitored closely in the post-operative period in the intensive care unit with complete invasive monitoring for up to a week to prevent factors resulting in worsening of the shunt (such as fluid balance) and thromboembolic phenomenon.- - - - - - - - - - ranking = 0.14285714285714keywords = pregnancy (Clic here for more details about this article) |
15/29. pregnancy outcome in patients with pulmonary arterial hypertension receiving prostacyclin therapy.BACKGROUND: Pregnancy is contraindicated in cases of pulmonary hypertension, a highly morbid disease affecting young women of childbearing age. CASES: We describe the pregnancies of 3 patients with pulmonary arterial hypertension (idiopathic, Eisenmenger syndrome, and related to systemic lupus erythematosus). They received epoprostenol and low-molecular-weight heparin throughout pregnancy. The patient with Eisenmenger syndrome started epoprostenol in gestational week 16. Cesarean delivery under general anesthesia was performed at 28-33 weeks of gestation; early delivery was necessary in the patient with Eisenmenger syndrome because of fetal growth restriction. All deliveries were uneventful, and birth weights were 1,700, 1,500, and 795 g. There were no postpartum complications. CONCLUSION: Pregnancy in women with pulmonary hypertension should still be considered high risk for both mother and child, but stable patients on epoprostenol may successfully complete pregnancy.- - - - - - - - - - ranking = 0.31329683049289keywords = pregnancy, gestation (Clic here for more details about this article) |
16/29. Pregnancy in the patient with Eisenmenger's syndrome.Eisenmenger's syndrome occurs when a large congenital or surgically created shunt between the left and right sides of the heart causes an increase in pulmonary vascular resistance that equals or surpasses systemic resistance, resulting in a reversal of the shunt from a left-to-right shunt to a right-to-left or bi-directional shunt. The maternal mortality rate of pregnancy in the presence of Eisenmenger's syndrome is reported to be as high as 50-65% with cesarean section. We present the case of a 32-year-old woman with Eisenmenger's syndrome who gave birth at 29 weeks of gestation via C-section to a healthy baby boy, and we review the literature regarding the management of such patients.- - - - - - - - - - ranking = 0.15664841524644keywords = pregnancy, gestation (Clic here for more details about this article) |
17/29. Caesarean section in undiagnosed Eisenmenger's syndrome. Report of a patient with a fatal outcome.An obstetric patient is described in whom the first sign of cardiac disease was unexplained hypoxaemia during emergency anaesthesia for antepartum haemorrhage, with an eventual fatal outcome. The case highlights the importance of patient information at the booking clinic, and the implications of a raised haemaglobin in early pregnancy.- - - - - - - - - - ranking = 0.14285714285714keywords = pregnancy (Clic here for more details about this article) |
18/29. Eisenmenger's syndrome in pregnancy: does heparin prophylaxis improve the maternal mortality rate?Seven consecutive patients with Eisenmenber's syndrome, cared for by the obstetric team in conjunction with the cardiology service, were reviewed to assess the possible role of prophylactic heparin therapy and intensive care on the outcome of these patients. In each patient, the diagnosis of Eisenmenger's syndrome was established by the demonstration of equal pulmonary arterial and aortic pressures with a predominantly right-to-left shunt at cardiac catheterization. Five of the seven patients died as follows: Three patients died between the fifth and eighth post-partum days, one patient died during the twenty-sixth week of pregnancy, and one patient died on the fifth postoperative day following tubal ligation. All of these five patients received prophylactic heparin therapy. In three patients, heparin therapy was complicated by excessive bleeding during the postoperative or postpartum period. autopsy examination in two patients revealed no evidence of thrombosis in the main pulmonary arteries and no pulmonary infarction, contrary to the antemortem clinical suspicion. The two survivors did not receive prophylactic heparin. They comprised one patient who had normal delivery and one patient who underwent tubal ligation and induction of abortion. We conclude that the prohibitive mortality rate of Eisenmenger's syndrome during pregnancy, puerpurium, or surgical procedures probably cannot be modified with prophylactic heparin therapy. Anticoagulant treatment does not prevent deterioration of patients and probably compounds the problem by causing significant bleeding.- - - - - - - - - - ranking = 0.85714285714286keywords = pregnancy (Clic here for more details about this article) |
19/29. Eisenmenger's syndrome and pregnancy.Two cases of successfully managed Eisenmenger's syndrome during pregnancy are reported. A women suffering from Eisenmenger's syndrome who becomes pregnant should be advised to have her pregnancy terminated. On the basis of the available literature and our own experiences we suggest the following plan, if a woman, despite medical advice, chooses to continue her pregnancy: admission to hospital at approximately 25 weeks of gestation; bed rest during the remaining period of pregnancy; oxygen face-mask during episodes of dyspnoea; determination of serial blood gases to detect changes in the shunt flow. At the onset of labour, arterial and epidural catheters should be inserted, a fall in blood pressure should immediately be counteracted by the administration of norepinephrine and loss of blood by transfusion. The patient should remain in hospital for 7-14 days after delivery.- - - - - - - - - - ranking = 1.1566484152464keywords = pregnancy, gestation (Clic here for more details about this article) |
20/29. Eisenmenger's syndrome and pregnancy.The Eisenmenger's syndrome (E.S.) was redefined by wood (1958) as pulmonary hypertension with reversed or bidirectional shunt at the aortopulmonary, ventricular or atrial level. This eponym is applicable to 12 different congenital cardiac lesions. Pregnancy in patients with E.S. is a particularly hazardous situation in respect to the prohibitive features of maternal and perinatal mortality (Gleicher et al., 1979; Jones & Howitt, 1965; Neilson et al., 1971).- - - - - - - - - - ranking = 0.57142857142857keywords = pregnancy (Clic here for more details about this article) |
| <- Previous || Next -> |