Anesthetic Management of Ovarian Bleeding with Eisenmenger's Syndrome: A case report / 대한마취과학회지

ABSTRACT

Eisenmenger's syndrome is defined as a high pulmonary vascular resistance associated with pulmonary hypertension or high pulmonary pressure close to systemic values with a reverse or bidirectional shunt at aortopulmonary, interventricular or interatrial levels. We report the case of a 42-year-old woman with an emergency operation for ovarian bleeding with Eisenmenger's syndrome secondary to large VSD. She had abdominal pain and vaginal spotting which developed one month earlier. In a preoperative abdominal ultrasonography, there was a fluid collection on the Cul-de-sac. There was no significant cardiorespiratory symptom except peripheral cyanosis. Anesthesia was performed with fentanyl, midazolam and vecuronium in standard monitorings including pulmonary artery pressure monitoring. Bolus and continuous infusions of amrinone were given to decrease right to left shunt. After the administration of amrinone, PaO2, PaO2/FiO2, P(A-a)O2 and P(a/A)O2 were improved and pulmonary arterial pressure was preferentially decreased compared with systemic arterial pressure. There was no significant problem throughout the operation, a right ovarian wedge resection. She was transferred to the intensive care unit in an intubated state postoperatively and discharged one week later without any complications.