Successful mitral valve reconstruction using autologous pericardium in a pregnant patient with severe infective endocarditis: a case report.

Background: A 34-year-old woman at 25 gestational weeks presented with severe respiratory distress secondary to heart failure caused by severe mitral regurgitation and infective endocarditis.

Case presentation: Transthoracic echocardiography revealed a large (17 mm) vegetation attached to the posteromedial commissure of the mitral valve leaflet. Owing to pulmonary edema and circulatory failure, she underwent emergency cesarean section to improve maternal hemodynamics. Postoperatively, her pulmonary edema resolved, and the hemodynamic status was stable. Thus, mitral valve surgery was scheduled 2 days later. Intraoperative findings confirmed that the posteromedial site of the mitral valve was severely damaged by vegetation and chordae tendineae rupture. The damaged mitral valve leaflet was resected, with seamless reconstruction using a glutaraldehyde-fixed autologous pericardium. Postoperative echocardiogram revealed no residual mitral regurgitation. Despite premature birth, the infant survived but required surgery for patent ductus arteriosus.

Conclusions: This case highlights that through timely intervention and advanced surgical techniques, a patient with severe infective endocarditis, despite being pregnant, can be successfully managed.