Jahangir Ahmad, Mohsen Nazir, Liaqat Ali, Javed Iqbal, Hamid Saeed.
Eisenmenger syndrome: a silent killer in adults born with heart septal defect: experience from cardiac centre at faisalabad.
Annals Punjab Med Coll Jan ;4(1):53-6.

Introduction: Eisenmenger syndrome is  a  term used to any large shunt between systemic and pulmonary circulation which results in high pulmonary arterial pressure and irreversible changes in pulmonary vascular bed with bidirectional shunt with physical limitation and shortness of breath. Eisenmenger syndrome particularly creates problems to fetus and mother in pregnancy and there is a particularly risk during aneasthesia while performing general surgery. Materials and Methods: We collected all consecutive patients above age 12 with atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA) who attended echocardiography department between June 2008 to October 2010.we also analysed all pregnant females with eisenmenger complex during this period. Results: Out of 309 patients diagnosis of one  of three shunts was confirmed either by transthorasic echocardiography with intravenous saline infusion or transesophageal echocardiography Eisenmenger syndrome was diagnosed in 39 patients (19 patients with ASD, 11 patients with VSD and 09 patients with PDA).  All 39 patients were followed till October 2010 and were alive. Among 03 pregnant females, 02 completed pregnancy without any hazard to child and  mother. However tubal ligation was opted at time of delivery. One lady opted abortion and ligation to prevent further pregnancy. 05 patients underwent non cardiac surgery under general anesthesia without any complication. Conclusion: Eisenmenger syndrome a silent killer in a congenital treatable disease which is being neglected and diagnosis is being delayed. It seems eisenmenger syndrome is on rise in Pakistan. We need to establish adult congenital heart disease department in each cardiac centre where trained persons should be appointed who had experience of congenital heart disease. Screening clinics need to be established at school and community level to diagnose this silent killer at a stage when pulmonary artery pressure is still reversible. 

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