Life-Threatening Rheumatic Valvular Heart Disease in Late Pregnancy: A Case Report and Literature Review

Background: Rheumatic heart disease (RHD) continues to pose serious risks during pregnancy, especially in low-resource settings. Case summary: We report the case of a 44-year-old Moroccan woman at 28 weeks gestation who presented with acute decompensated heart failure due to undiagnosed severe mitral stenosis (valve area 0.4 cm²) and tricuspid regurgitation, secondary to RHD. Clinical evaluation revealed pulmonary hypertension and signs of congestive heart failure. Given the high maternal-fetal risk and lack of percutaneous valvuloplasty facilities, a multidisciplinary team opted for urgent mitral valve replacement and tricuspid valve repair. Postoperative recovery was favorable, with resolution of pulmonary hypertension and stable fetal status. Conclusion: This case underscores the need for early screening, diagnosis, and a collaborative care approach to mitigate morbidity and mortality in pregnant women with valvular heart disease. It highlights how timely surgical intervention, even during late pregnancy, can improve outcomes when specialized care is accessible.