Segmental Spinal Anaesthesia Combined with TAP Block for Caesarean Section in a Patient with Eisenmenger Syndrome: A Case Report

Pregnancy in patients with Eisenmenger Syndrome (ES) is associated with extremely high maternal and foetal morbidity and mortality, and anaesthetic management for caesarean section is particularly challenging because of fixed pulmonary hypertension, right-toleft shunting, and limited cardiovascular reserve. Present case report is of a 35-year-old gravida 3 with two previous abortions, diagnosed with ES, who presented at 35 weeks of gestation for elective caesarean section due to severe oligohydramnios and intrauterine growth restriction. Cardiac evaluation revealed a large Ventricular Septal Defect (VSD) with Patent Ductus Arteriosus (PDA) and bidirectional shunting, moderate-to-severe Tricuspid Regurgitation (TR), left ventricular systolic dysfunction with an ejection fraction of 45%, secondary polycythaemia, thrombocytopenia, and baseline oxygen saturation of 84% on room air. Following detailed multidisciplinary planning, segmental spinal anaesthesia was administered using low-dose isobaric ropivacaine with fentanyl under invasive haemodynamic monitoring. A prophylactic noradrenaline infusion was commenced to maintain Systemic Vascular Resistance (SVR) and prevent hypotension. Caesarean delivery was completed uneventfully with stable maternal haemodynamic throughout the procedure. A low-birth-weight neonate was delivered and managed in the Neonatal Intensive Care Unit (NICU). Postoperative analgesia was provided using bilateral Transversus Abdominis Plane (TAP) block, allowing effective pain control without significant haemodynamic compromise. The patient was monitored in a cardiac intensive care unit and had an uneventful postoperative course before discharge in stable condition. This case demonstrates that with meticulous multidisciplinary planning, invasive monitoring, judicious fluid administration, early vasopressor support, and low-dose segmental spinal anaesthesia, caesarean section can be safely accomplished in carefully selected patients with ES. However, pregnancy in ES remains extremely high risk and should to be strongly discouraged.