Eisenmenger syndrome (ASD, VSD, PDA With PAH with reversal of shunt – Right-to–Ieft shunt)
- Eisenmenger described a syndrome in which pulmonary vascular disease developed in patients with a nonrestrictive ventricular septal defect,
- There is cyanosis, JVP is normal, there is no parasternal heave, palpable pulmonary trunk in left second intercostal space. There are signs of pulmonary hypertension – pulmonary ejection systolic murmur, pulmonary ejection sound, loud and single S2, Graham Steell murmur.
- The triad of systemic-to-pulmonary communication, pulmonary vascular disease and cyanosis is called Eisenmenger syndrome,
- diagnosis of Eisenmenger syndrome requires the presence of congenital heart disease,
- Physical examination of the patient with Eisenmenger syndrome demonstrates central cyanosis and digital clubbing,
- risk of developing the Eisenmenger syndrome appears to be determined by the size of the initial left-to-right shunt
- Shows normal or right atrialp tricular hyportrophy.
- Shows oligemic lung fields, dilated pulmonary trunk and central branches and normal cardiac shadow.
- chest x-ray usually shows dilatation of the central pulmonary arteries, peripheral pulmonary artery “pruning”
- Infective endocarditis
- Coagulation defects
- Cerebral infarction or abscess
- Paradoxic embolism
Eisenmenger syndrome Treatment
- Corrective operation should be done at suitable age.
- If there is marked hypoplasia of pulmonary arteries, a palliative operation like a systemic arterial to pulmonary arterial shunt is done followed by complete correction years later.