Background and Objectives: Pregnancy and delivery in patients with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH) carry a very high risk for maternal and foetal complications and are contraindicated according to the guidelines. In the last decades, when an available modern PAH-targeted medication therapy and a new management concept improved patients’ well-being and survival, some PAH-CHD females decided to conceive. Of note, despite advanced treatment and modern healthcare system possibilities, dealing with pregnancy in a diverse PAH-CHD population is still challenging. The study aimed to share our experience with PAH-CHD pregnancies and discuss the risk assessment and current management of these patients with the combination of two rare diseases. Materials and Methods: The retrospective search of pulmonary hypertension and adult CHD registries in our hospital was performed, selecting all patients with CHD and PAH who conceived pregnancy from 2013 to 2021. Baseline demographic, clinical, and functional characteristics and clinical outcomes were collected. Results: Thirteen pregnancies in eight patients with PAH-CHD resulted in seven live births, three miscarriages, and three terminations. Five women were diagnosed with Eisenmenger syndrome (ES) and three with residual PAH after CHD repair. Before pregnancy, half of them were in WHO functional class III. Seven (87.5%) patients received targeted PAH treatment with sildenafil during pregnancy. In addition, the two most severe cases were administered with iloprost during peripartum. Three ES patients delivered preterm by Caesarean section under general anaesthesia. No neonatal mortality was reported. Maternal complications were observed in half of our cases. One patient died 12 days after the delivery in another hospital due to deterioration of heart failure. Conclusions: On the basis of our clinical experience, we conclude that pregnancy and delivery carry a high risk for maternal complications and should be avoided in women with PAH-CHD. The individualised approach of multidisciplinary care and appropriate monitoring are mandatory in reducing the risk of adverse outcomes.

Background. The surgicalstressinduced release of hormones, such as ca techolamines (norepinephrine and epinephrine), adrenocorticotropic hor mone (ACTH), and cortisol, via the autonomic nervous system and the hypothalamicpituitaryadrenal axis (HPA) mediates inhibitory effects on immune functions. Pain management may influence the immune response in the postoperative period. The goal of the present study was to examine to what extent postoperative pain management modulates the surgeryinduced alterations of the immune response, specifically, interleukin6, cortisol and C reactive protein (CRP); to compare effects of two pain management tech niques, based on NSAID and continuouos epidural infusion of a local anaes thetic and morphine mixture.Materials and methods. Local Bioethics Committee's approval was re ceived, patients ASA I-III scheduled for laparoscopic colorectal surgery (LCS) were randomised to receive general anesthesia (GA, N = 27) or combined ge neral anesthesia with epidural analgesia (EA, N = 26). Anesthesia was induced with propofol, fentanyl and atracurium and maintained with sevoflurane. The EA group received the first dose of 3 mg epidural morphine with 0.25-0.125% bupivacaine mixture 20-30 min before surgery and continuous epidural infu sion of bupivacaine 0.25% and 5 mg of a morphine mixture for postopera tive analgesia. The GA group received intravenuous fentanyl and morphine during surgery, and NSAID for postoperative pain management. There were 5 cases when laparoscopy was converted to open surgery due to surgery find ings, these cases made the thirdconversion group (CG) with further mainte nance intended analgesia type. Pain was evaluated using the visual analogue scale (VAS) after anaesthesia and 24 hours later. Venous blood samples for cortisol and interleukin6 were taken preoperatively before induction of ana esthesia (baseline), after surgery and 24 hours after baseline. Venuous blood samples for CRP were checked after 1, 2, 3, 4, 6 days after surgery. Collected data were stored in the data base and were analysed using SPSS for Windows Version 19.0. The data were analysed using the MannWhitney U test and Stu dent's t test for comparison of 2 groups and ANOVA for comparison of more than two groups. The Bonferroni adjustment was used to detect pairwise dif ferences between the groups. The Chisquare test was used to determine dif ferences between categorical variables. Differences between the groups were considered statistically significant at p < 0.05. 245Impact of anesthesia method on cortisol and interleukin6 concentration changes during... Results and discussion.There were statistically significant differences be tween the groups in pain score after surgery (p < 0.001) and 24 hours later (p < 0.000) and in bowel motility after anaesthesia (p < 0.001). In EA group bowel motility was observed in 96.2% of patients after surgery and lasted more than 24 hours despite of infusion of local anesthetic mixture with morphine. In the GA group only in 55.6% of cases bowel motility was observed after...

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