Anesthetic management and role in a patient with severe pulmonary hypertension with Eisenmenger physiology undergoing a cesarean section

Objective: To elucidate the challenges associated with anesthesia and successful management strategies in a pregnant patient with severe pulmonary arterial hypertension and Eisenmenger physiology undergoing cesarean section. Background: Congenital heart disease is a leading cause of maternal cardiac deaths, with Eisenmenger's syndrome being high-risk due to potential complications. Pulmonary hypertension, characterized by an increase in mean pulmonary artery pressure, is associated with a high mortality rate between 30% and 56%. Advancements in medicine have improved the prognosis and quality of life for patients with pulmonary arterial hypertension. However, managing cesarean sections for parturients with Eisenmenger's syndrome remains challenging. Case notes: A 27-year-old primigravida with severe pulmonary arterial hypertension secondary to congenital heart disease, diagnosed with Eisenmenger physiology, underwent an emergency cesarean section at 32 weeks for optimal maternal and fetal outcomes. The multidisciplinary team opted for careful pre-operative assessment and invasive monitoring along with epidural anesthesia. Postoperatively, the patient faced complications, including thrombocytopenia, hematoma, and a positive COVID-19 diagnosis, yet was discharged in stable condition. Conclusion: Continuous vigilance throughout the perioperative and postoperative phases is crucial for optimizing outcomes in pregnant patients with Eisenmenger physiology. The successful outcome in this high-risk case underscores the importance of advanced medical modalities and multidisciplinary approaches in addressing the complexities of such pregnancies.