BoardsBridgeEisenmenger Syndrome in Adult Congenital Heart Disease (ACHD) — Anesthetic Management
Irreversible reversal of a left-to-right intracardiac shunt once pulmonary vascular resistance exceeds systemic — high perioperative risk during noncardiac surgery.
Eisenmenger syndrome is the irreversible reversal of a left-to-right intracardiac shunt (VSD/ASD/PDA) to right-to-left once pulmonary vascular resistance exceeds systemic vascular resistance, producing chronic cyanosis, erythrocytosis, and high perioperative risk for noncardiac surgery.
If you forget
Eisenmenger = PVR > SVR → R→L shunt → cyanosis; Qp/Qs falls below 1.
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Key numbers
- Qp/Qs < 1 = net right-to-left; Qp/Qs > 1 = net left-to-right; Qp/Qs = 1 = balanced (Miller's Ch. 73).
- Intraop BP goal: MAP ≥60–65 mm Hg or SBP ≥90 mm Hg (2024 AHA/ACC perioperative guideline).
- Pressure-overload physiology takes 'years' to cause ventricular dysfunction/failure in isolated lesions (Miller's Ch. 73).
- Vasodilators in shunting physiology may decrease both PVR and SVR, increase extrapulmonary shunting, and further reduce pulmonary blood flow (Miller's Ch. 75).
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: Millers Anesthesia 10 Ch73 Anesthesia FOR Pediatric Cardiac Surgery · AHA ACC Perioperative Cardiovascular 2024 · Millers Anesthesia 10 Ch75 Pediatric AND Neonatal Critical Care · Millers Anesthesia 10 Ch50 Anesthesia FOR Cardiac Surgical Procedures
Re-review cadence: 12 months from reviewed date.
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Card ID: eisenmenger · Path: aba.cardiac.congenital-adult.eisenmenger