Update for nurse anesthetists. Eisenmenger syndrome: an anesthetic conundrum

Eisenmenger syndrome is an insidious disease entity. This disease is characterized by an unrepaired congenital heart defect and left-to-right cardiac shunting. After many years of increased blood flow through the pulmonary system as a result of the shunting, damage to the pulmonary vessels occurs, culminating in severe pulmonary hypertension. The pulmonary hypertension eventually causes the cardiac shunt to reverse direction. The right-to-left shunt results in a very debilitated patient. There is no known medical cure for this disease; the only curative option is heart-lung transplantation or bilateral lung transplantation with repair of the patent heart defect. Because of the great strides in medical care, more patients with Eisenmenger syndrome require anesthesia. Maintaining the patient's systemic vascular resistance at the preoperative level is of paramount importance. Choosing the best anesthesia technique is difficult, at best.