SARS-CoV-2 pneumonia and Eisenmenger's syndrome: doubling the challenge.

Eisenmenger's syndrome (ES) is the most severe phenotype of pulmonary arterial hypertension secondary to congenital heart disease. In these cases, significant systemic-to-pulmonary (left-to-right) shunting triggers the development of pulmonary vascular disease and pulmonary hypertension. In cases of acute hypoxemic respiratory failure in patients with ES, high-flow nasal cannula (HFNC) oxygen therapy should be considered as a first-line approach in order to avoid pulmonary complications and right ventricular overload related to positive pressure ventilation. Here, we report a case of HFNC use in a patient with COVID-19 infection and ES.