An 18-month-old child with unrepaired VSD is found to have reversal of the cardiac shunt — now right-to-left — causing central cyanosis, finger clubbing, and pulmonary hypertension. The pulmonary vascular resistance now exceeds systemic vascular resistance. This pathophysiological syndrome is:
- A Lutembacher syndrome
- B Eisenmenger syndrome ✓
- C Tetralogy of Fallot
- D Truncus arteriosus
Correct answer: B. Eisenmenger syndrome
Explanation
Eisenmenger syndrome develops when prolonged left-to-right shunts (from large unrepaired VSD, ASD, or PDA) cause progressive pulmonary arterial hypertension to the point where pulmonary vascular resistance exceeds systemic vascular resistance, reversing the shunt direction to right-to-left, causing cyanosis. Once Eisenmenger physiology is established, surgical repair is contraindicated (fatal hypotension). Management includes targeted pulmonary vasodilators (sildenafil, bosentan) and ultimately heart-lung transplantation.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.