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Eisenmenger Syndrome and Pregnancy: Novel ECMO Configuration as a Bridge to Delivery and Recovery Utilizing a Multidisciplinary Team

Rosenzweig, Erika B.*; Abrams, Darryl; Biscotti, Mauer; Kerstein, Diane*; Drassinower, Daphnie§; Brodie, Daniel; Bacchetta, Matthew

doi: 10.1097/MAT.0000000000000548
Case Reports

Pregnancy is typically contraindicated in Eisenmenger syndrome because of its association with excessively high maternal and fetal morbidity and mortality. Here, we report on our novel approach to successfully managing a 29 year old pregnant woman with an unrepaired patent ductus arteriosus (PDA) with Eisenmenger syndrome through delivery and recovery. Venovenous extracorporeal membrane oxygenation (ECMO) was utilized during induction of labor to stabilize maternal hemodynamics and optimize fetal oxygenation by creating an oxygenated right-to-left shunt through the PDA. Delivery ultimately required cesarean section on ECMO support, with her hospital course complicated by intraabdominal hemorrhage and, later, recannulation with venoarterial ECMO for postoperative respiratory failure with decompensated pulmonary hypertension. Ultimately, both the mother and baby were successfully discharged to home. This case highlights not only the potential for ECMO in the peripartum setting for patients with severe pulmonary hypertension, but also the complexity of management and the need for a highly experienced, multidisciplinary team.

From the *Department of Pediatrics, Columbia University Medical Center, New York, New York; Department of Medicine, Columbia University Medical Center, New York, New York; Department of Surgery, Columbia University Medical Center, New York, New York; and §Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York.

Submitted for consideration June 2016; accepted for publication in revised form November 2016.

Brodie and Bacchetta are co-senior authors.

Disclosure: Dr. Brodie is currently on the medical advisory boards of ALung Technologies and Kadence. All compensation for these activities is paid to Columbia University.

Correspondence: Erika B. Rosenzweig, Division of Cardiology, Department of Pediatrics, Pulmonary Hypertension Center, Columbia University Medical Center, 3959 Broadway, CH-2N, New York, NY 10032. Email: esb14@cumc.columbia.edu.

Copyright © 2018 by the American Society for Artificial Internal Organs