Double Trouble in the Delivery Room: Anesthetic Management of Emergency Caesarean Section in a Parturient with Severe Mitral Stenosis and Aortic Stenosis

Parturients with severe mitral and aortic stenosis [modified World Health Organization Class (mWHO) IV] carries high maternal and fetal risk, particularly during emergency caesarean section. A 33-year-old woman at 35 weeks gestation, diagnosed with chronic rheumatic heart disease involving severe mitral stenosis (mitral valve area 0.9 cm 2 ), severe aortic stenosis (peak velocity 4.53 m/s), moderate aortic regurgitation, and severe pulmonary hypertension, underwent emergency caesarean section. General anesthesia (GA) with invasive hemodynamic monitoring, cautious fluid and vasopressor management, and intensive postoperative care ensured maternal stability and favorable outcome. This case underscores the complexities of anesthetic management in parturients with combined severe mitral and aortic stenosis, both classified as mWHO Class IV lesions with extremely high maternal risk. The physiological changes of pregnancy, compounded by the stress of emergency surgery, can precipitate decompensation in these patients. GA with invasive monitoring was selected to provide precise control over hemodynamic parameters, avoiding the risks of neuraxial-induced hypotension. Judicious fluid management, early vasopressor use, and a multimodal analgesic approach contributed to a stable intraoperative course and favorable maternal–fetal outcomes. Women with mWHO Class IV valvular lesions require individualized anesthetic strategies, multidisciplinary approach involving pregnancy heart team, and specialized care to optimize outcomes during high-risk pregnancy.