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Background and Aims The incidence of Eisenmenger’s Syndrome(ES) in pregnant women is 3% and the mortality rate is reported to be 30-50%. Right heart failure, pulmonary hypertension, arrhythmia and hypovolemia are the main causes of mortality. Successful perioperative management of pregnant patients with ES planned for cesarean section is a challenging process for anesthesiologists. We present a case of cesarean section facilitated by dural puncture epidural(DPE) anesthesia with optimal outcome in a pregnant patient with ES.

Methods Case A 28-year-old primigravida (weight 59 kg, height 157 cm) at 34-week gestation was referred to our hospital for VSD with ES. In the operating room, standard monitoring, including SpO2, noninvasive blood pressure, and ECG, was established. The epidural was performed in the sitting position at the L3/4 interspace via the midline approach using a 17-gauge Touhy needle and a loss of resistance to saline technique. The dura was punctured with a 25-gauge, pencil-point needle using a needle-through-needle technique, and spontaneous return of cerebrospinal fluid was confirmed. After observing free flow of CSF, the needle was removed without the injection of any drug. After the negative test dose, we injected a total of 16 mL of bupivacaine 0.50% in 5-mL increments every 2 min through the epidural catheter.

Results The caesarean section proceeded uneventfully.

Conclusions It is reported that DPE anesthesia has a faster onset and better block quality than EA anesthesia and has less maternal hemodynamic effects than CSE. İn our case report, DPE techniques can be an option to facilitate caesarean section in pregnant patients with ES.