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2026 SOAP Annual Meeting
April 29 - May 3, 2026 | Montreal, Quebec Canada
2339496
Management of a Previable Patient with Severe Aortic Valve Endocarditis with Aortic Valve Insufficiency, Requiring VV-ECMO for Bronchospastic Respiratory Failure
Part of Topic
Respiratory challenges
Clinical Problem: Infective Endocarditis in Pregnancy
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Infective endocarditis (IE) in pregnancy is rare but associated with 10–15% mortality
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Pregnancy Physiology:
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Increased cardiac output & plasma volume, and decreased SVR can mask or worsen valvular disease
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Acute aortic insufficiency (AI) is poorly tolerated vs. chronic AI
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Aortic root abscess
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Rare in pregnancy
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Increase risk of rupture with advancing gestation/postpartum
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Termination of pregnancy (TOP)
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Important option in previable patients with high-risk cardiac disease
19w Pregnant Patient with Severe IE
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28F, 19w EGA
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PMH: bicuspid AV, polysubstance use, anxiety
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Presentation: dyspnea, chest pain, fentanyl withdrawal
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Workup: S. mitis bacteremia, TTE: severe AI + multipleAV vegetations
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Multidisciplinary decision: TOP via D&E
Intraoperative Course
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Induction: ketamine, midazolam, propofol
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Required dobutamine + norepinephrine
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TEE findings:
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LVEF 45–50%
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Severe AI, mobile vegetations
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Aortic root abscess
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Left pleural effusion
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Complication: severe bronchospasm → ICU + ventilator
Postoperative Course
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Extubated POD1
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Later underwent Bio-Bentall procedure
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Developed respiratory failure → VV-ECMO (POD1)
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Extubated POD4, decannulated POD8
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Gradual cardiac recovery → discharge to SNF
Clinical & Anesthetic Takeaways
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Acute severe AI ≠ chronic AI
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High risk for rapid decompensation in pregnancy
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Aortic root abscess
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Rare but critical → risk of rupture with ↑ CO and aortic dilation
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Anesthetic considerations
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Avoid afterload increase
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Maintain forward flow (inotropes often required)
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Be prepared for hemodynamic instability + possible respiratory failure
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Multidisciplinary care is critical
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Cardiology, cardiac surgery, MFM, anesthesia, ICU
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Termination of pregnancy
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Should be early, patient-centered, and clearly discussed in previablehigh-risk cases