A 5-year-old child with known unrepaired VSD presents with increasing cyanosis and clubbing over the past year. Echocardiography now shows right-to-left shunting across the VSD and severe pulmonary hypertension. PVR/SVR ratio is 0.8. This child's condition is best characterised as:

• A Pulmonary arterial hypertension secondary to VSD
• B Primary pulmonary hypertension
• C Large restrictive VSD with bidirectional shunting
• D Eisenmenger syndrome ✓

Explanation

Eisenmenger syndrome refers to the development of severe, irreversible pulmonary arterial hypertension from initially left-to-right shunts (VSD, ASD, PDA) that causes shunt reversal (right-to-left), resulting in cyanosis. Surgical correction is contraindicated at this stage because the pulmonary vasculature disease is fixed. A PVR/SVR ≥0.5 with cyanosis defines Eisenmenger physiology. Medical therapy with pulmonary vasodilators (bosentan, sildenafil) may improve exercise tolerance but does not cure the condition.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.