A case of rheumatic heart disease diagnosed in the third trimester

Migration from areas with a high incidence of rheumatic heart disease has led to an increase in pregnancy complicated by rheumatic heart disease in high-income countries. We present a case of rheumatic heart disease diagnosed in a 33-year-old G2P0010 French-speaking Congolese woman at 32 weeks gestation. She was initially hospitalized with respiratory syncytial virus (RSV) bronchiolitis at 24 weeks gestation and established care in our clinic. Mitral valve stenosis was identified at 32 weeks gestation after she presented with severe edema and was hospitalized for acute on chronic heart failure complicated by urosepsis and cellulitis. She was managed in the cardiovascular intensive care unit with a subsequent emergent cesarean delivery at 33 weeks gestation for nonreassuring fetal status. Postoperatively, pulmonary artery pressures were 40 mm Hg and left ventricular ejection fraction was 35%. Her condition stabilized and she was discharged home with outpatient cardiology management on postoperative day 10 with baby in the NICU. This case illustrates the importance of a high threshold of suspicion for women at risk for complications of heart disease in pregnancy. A triad of cardiovascular risk screening, patient education and multidisciplinary team planning with maternal-fetal medicine, cardiology, and anesthesiology has been shown to optimize outcomes in women with known cardiovascular disease.