SINDROME DE EINSENMENGER Y EMBARAZO

RESUMEN Se presenta un caso clinico de una paciente de 21 anos, M1, portadora de un Sindrome deEinsenmenger diagnosticado posterior a su primer parto, que ingresa a la Unidad de Alto Riesgo Obstetricodel Hospital San Juan de Dios cursando un Embarazo de 14 sem, en capacidad funcional III, oxigeno -dependiente, la paciente se maneja con tratamiento medico hasta lograr viabilidad fetal, a las 28 sem sedecide interrupcion del embarazo dado el compromiso materno progresivo, con riesgo vital y deterioro fetal.Se realiza cesarea electiva por un equipo multidisciplinario y multicentrico, obteniendose un RN vivo enbuenas condiciones, sin incidentes anestesicos ni quirurgicos durante el procedimiento. La pacienteevoluciona en el puerperio inmediato con inestabilidad hemodinamica y shock cardiogenico, falleciendo alas 39 horas de puerperio. Se analiza el tema del Sindrome de Einsenmenger, su manejo actual, mal pronostico, y la contraindi-cacion de embarazo dado su alta mortalidad materna y compromiso fetal.PALABRAS CLAVES: Sindrome de Einsenmenger, embarazoSUMMARYWe present a clinical case of a 21 year old patient, in her second pregnancy (multiparous 1), with thediagnose of Einsenmenger's Syndrome. The diagnosis was made after her first delivery. She was admittedat the High Risk Obstetric Unit during her 14 week of the second pregnancy. On admission she hadFunctional Capacity (FC) III and oxygen-dependent. She was managed medically up to 28 weeks; due tothe progressive maternal compromise with vital risks and fetal damage, a preterm cesarean section wasperfomed by a multicentric and multidisciplinary team. The result was a newborn alive, and during theintervention there weren't anesthetical or surgical incidents. The patient was, since the delivery, with hemodinamic instability and cardiogenic shock. She died 39hours after the delivery, despite all medical efforts. We review the Einsenmenger's syndrome, the actual management, bad prognosis and the need ofpreventing pregnancy in these patients due to the high maternal mortality risk and fetal compromise.KEY WORDS: Einsenmenger's Syndrome, pregnancy