A 24-year-old woman is shows up in the ED, 27-weeks pregnant, febrile and with mental status changes. And, BTW, she has a history of intravenous drug abuse. And she has missed most of her prenatal visits.
During her work, whe is noted to have a significant diastolic murmur. Echo shows endocarditis of the aortic valve with wide open aortic regurgitation. The fetus looked fine. Due to risk of decompensation with probably fatal consequences for mother and fetus, the decision was made to take the patient to the OR for first a Cesarean and then aortic valve repair (AVR).
Fast forward 6 hours – the baby is in the NICU. Apgars were 8 and 9. The mother is in the ICU, after a AVR witha #21 bioprosthetic valve on low dose Norepinephrine and Propofol! Her hemodynamics are stable as a rock and there is no sign of bleeding.
Not only cats have 9 lives!