Anesthetic Management of a Patient with Eisenmenger Syndrome Undergoing Medical Termination of Pregnancy

Eisenmenger syndrome (ES) is a complication that arises from uncorrected congenital heart disease due to large defects that lead to anatomic shunts. Initially, a left-to-right shunt is present because of anatomical variations at birth. Over time, as pulmonary vascular resistance increases and severe pulmonary artery hypertension develops, a right-to-left shunt occurs. This switch results in hypoxemia and cyanosis, which poses significant risks to both the mother and the fetus. The maternal mortality rate during pregnancy in patients with Eisenmenger syndrome is reported to be as high as 30–70%. The aim of this case report is to explore the use of a low-dose combination of local anesthetics and opioids as a trigger-free anesthetic technique for pregnant patients with ES undergoing medical termination of pregnancy. Our experience suggests that this technique can be a safe and effective strategy for managing similar high-risk pregnant patients with ES who require short-duration procedures.