The Eisenmenger Syndrome involves secondary pulmonary hypertension with a right-to-left shunt in a patient with congenital heart disease. Administration of radiocontrast material in these patients can result in a variety of serious complications.
Effects of radiocontrast material:
(1) hypertonic load
(2) systemic arterial vasodilation
Consequences of the systemic arterial vasodilation in a patient with Eisenmenger Syndrome:
(1) hypotension
(2) worsening of the right-to-left shunt, with worsening hypoxemia and cyanosis
(3) increased blood viscosity, especially in patients with erythrocytosis
(4) thromboembolic phenomenon, including stroke
(5) precipitate or worsen heart failure
Therefore radiocontrast material in a patient with Eisenmenger syndrome should only be used when necessary, with the lowest possible dose, and with all due precautions. A low osmolality contrast material should be considered.
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