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Management of Eisenmenger Syndrome in Pregnancy With Sildenafil and l-arginine

Héctor J. Lacassie, MD^*, Alfredo M. Germain, MD^*, Gloria Valdés, MD^*, M Soledad Fernández, MD^*, Francisco Allamand, MD and Héctor López, MD

*Pontificia Universidad Católica de Chile, and Clínica Santa María, Santiago, Chile

Address reprint requests to: Alfredo M. Germain, MD, Department of Obstetrics and Gynecology, Catholic University School of Medicine, Lira 85-5o Piso, Santiago, Chile; e-mail: agermain{at}med.puc.cl.

BACKGROUND: Eisenmenger syndrome in pregnancy may be a life-threatening disease despite recent additions to the treatment options.

CASE: We present a woman with severe pulmonary hypertension due to Eisenmenger syndrome treated during pregnancy and delivery and postpartum with l-arginine and sildenafil to enhance the nitric oxide pathway. This combination was associated with significant improvement in the mother's clinical and hemodynamic condition and fetal well-being.

CONCLUSION: The concomitant use of sildenafil and l-arginine for the management of pulmonary hypertension in pregnancy, combined with multidisciplinary care, permitted a good outcome for the mother and her infant.

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