Successful Anesthetic and Perioperative Management of Severe Rheumatic Mitral Stenosis with Pulmonary Hypertension in a Pregnant Woman: A Case Report

Background Rheumatic heart disease (RHD) remains a significant cause of maternal morbidity and mortality, particularly in low- and middle-income countries. Severe mitral stenosis (MS) with pulmonary hypertension during pregnancy presents formidable challenges for anesthetic management. Case Presentation: A 27-year-old primigravida at 30 weeks gestation presented with acute cardiac decompensation secondary to severe rheumatic MS (mitral valve area 1 cm²), severe mitral and tricuspid regurgitation, and pulmonary hypertension (86 mmHg). She deteriorated from NYHA class II to IV with hypoxemia (SpO₂ 84%). A multidisciplinary team coordinated her care, optimizing her preoperatively in the ICU. Emergency cesarean section was performed under low-dose spinal anesthesia (bupivacaine 2.5 mg with fentanyl 50 mcg) supplemented with bilateral transversus abdominis plane (TAP) block. Hemodynamic stability was maintained without cardiac decompensation. The patient was discharged on postoperative day 7 in stable condition. Conclusion This case demonstrates that low-dose neuraxial anesthesia combined with TAP block offers a safe anesthetic approach for cesarean delivery in patients with severe valvular heart disease and pulmonary hypertension, provided meticulous hemodynamic monitoring and multidisciplinary care are ensured. Trial registration Not applicable.