Favorable maternal and neonatal outcomes in probable Eisenmenger physiology with suspected DORV: a case report and literature review

Abstract

Pregnancy in Eisenmenger syndrome is associated with very high maternal and fetal risk. Complex congenital anatomy further complicates diagnosis and peripartum management, particularly where advanced imaging and pulmonary hypertension therapies are limited. Published evidence specifically addressing pregnancy with uncorrected DORV and Eisenmenger physiology remains sparse. A 25-year-old primigravida at 34 weeks’ gestation presented with progressive dyspnoea and generalized oedema. The available record documented a heart rate of 130 beats/min, respiratory rate of 25 breaths/min, oxygen saturation of 80% despite face-mask oxygen, a loud second heart sound, and a systolic murmur. Echocardiography showed large ventricular and atrial septal defects with colour Doppler flow, severe tricuspid regurgitation, and an estimated systolic pulmonary artery pressure of 85 mmHg. In the setting of marked hypoxaemia, these findings supported probable Eisenmenger physiology, although shunt direction and pulmonary vascular resistance were not documented. The aorta appeared to arise predominantly from the right ventricle, supporting suspected DORV, but the origin of both great arteries, VSD-great-artery relationship, and DORV subtype could not be defined. Following cardiology and obstetric assessment, labour was induced and vaginal delivery occurred four hours later. The liveborn neonate weighed 2.7 kg, had an initial Apgar score of 5, and was admitted to neonatal intensive care for stabilisation and monitoring. Postpartum haemoglobin fell to 7 g/dL and two units of packed red cells were transfused. The mother was monitored in intensive care for three days, transferred to cardiology on day 6, and discharged in stable condition on day 7. This report documents maternal survival through induced vaginal delivery and the first postpartum week, with a live birth, despite late recognition of probable Eisenmenger physiology and suspected complex congenital heart disease. The report does not establish the safety of vaginal delivery in Eisenmenger syndrome, and incomplete haemodynamic, anatomical, anaesthetic, and neonatal data limit causal interpretation.