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Anaesthetic Management of a Known Case of Eisenmenger��?s Syndrome Posted for Elective Caesarean Section.

Anuja G Thakkar, Komal R Soni, Dhara Patel, Shakuntala J Goswami, and Indu A Chadha

Eisenmenger’s syndrome is a cyanotic congenital heart disease that includes pulmonary hypertension with reversed or bidirectional shunt. Pregnancy induced physiological changes include decrease in systemic vascular resistance and increase in cardiac output.the decreased systemic vascular resistance associated with pregnancy increases the degree of right to left shunt which carries risk to mother and foetus both. Anaesthetic management of such a case requires balance between systemic and pulmonary vascular resistance.we present a case of a 25 years old, primigravida with eisenmanger’s syndrome (large vsd and rvsp of 115 mm of hg) at 38 weeks of gestation posted for elective caesarean section.endotracheal anaesthesia with inj. Fentanyl, inj. Ketamine and inj. Vecuronium bromide was given and maintained on oxygen and sevoflurane. Intraoperative period was uneventful. On 3rd post-operative day patient developed tachycardia, tachypnoea, hypotension and decrease in oxygen saturation. She became unconscious and diagnosed as pulmonary thromboembolism. She died on the same day. Thromboembolic phenomena as a complication of eisenmanger’s syndrome in pregnancy is a challenging situation to treat in postoperative period.