Anaesthetic management of a patient with eisenmenger’s syndrome for caesarean section

Introduction: Eisenmenger’s syndrome is a serious complication of congenital heart defects. It involves high pulmonary artery pressures and reversal of blood flow through a cardiac shunt (right-to-left), leading to significant cyanosis. In pregnancy, these patients are at high risk because normal pregnancy-related changes such as reduced systemic vascular resistance can worsen the right-to-left shunt and hypoxemia. Maternal mortality rates of 30-70% have been reported in such cases. Case summary: We present the anaesthetic management of a 29-year-old primigravida with a large peri membranous ventricular septal defect (VSD) and Eisenmenger’s syndrome at 37 weeks of gestation. She required an elective caesarean section due to severe foetal growth restriction (FGR) and oligohydramnios. After a multidisciplinary discussion, we administered a carefully titrated epidural anaesthetic to achieve a sensory block to T6. Invasive arterial monitoring was used to quickly detect and correct any drops in blood pressure. Postoperative analgesia was maintained with a bilateral transversus abdominis plane (TAP) block and a continuous low-dose epidural infusion of local anaesthetic. The patient’s perioperative course was uneventful, and she recovered well. Conclusion: This case underscores the importance of vigilant haemodynamic control, comprehensive monitoring, and adequate postoperative pain management in obstetric patients with Eisenmenger’s syndrome. Suitable thromboprophylaxis and close coordination among obstetricians, cardiologists, and anaesthesiologists can help optimize both maternal and neonatal outcomes.