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2026 SOAP Annual Meeting

April 29 - May 3, 2026 | Montreal, Quebec Canada

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2339496

Management of a Previable Patient with Severe Aortic Valve Endocarditis with Aortic Valve Insufficiency, Requiring VV-ECMO for Bronchospastic Respiratory Failure

Poster Presenter

Ian Funk

Authors

Ian Funk, Afif Kraitem, Elise Boos, Kaitlyn Brennan

Affiliations

Vanderbilt University Medical Center, Department of Anesthesiology, Vanderbilt University Medical Center, Department of Obstetrics and Gynecology

Part of Topic

Respiratory challenges


Clinical Problem: Infective Endocarditis in Pregnancy

  1. Infective endocarditis (IE) in pregnancy is rare but associated with 10–15% mortality

  2. Pregnancy Physiology:

    • Increased cardiac output & plasma volume, and decreased SVR can mask or worsen valvular disease

  3. Acute aortic insufficiency (AI) is poorly tolerated vs. chronic AI

  4. Aortic root abscess

    • Rare in pregnancy

    • Increase risk of rupture with advancing gestation/postpartum

  5. Termination of pregnancy (TOP)

    • Important option in previable patients with high-risk cardiac disease

19w Pregnant Patient with Severe IE

  • 28F, 19w EGA 

  • PMH: bicuspid AV, polysubstance use, anxiety 

  • Presentation: dyspnea, chest pain, fentanyl withdrawal

  • Workup: S. mitis bacteremia, TTE: severe AI + multipleAV vegetations

  • Multidisciplinary decision: TOP via D&E

 

Intraoperative Course

  • Induction: ketamine, midazolam, propofol 

  • Required dobutamine + norepinephrine 

  • TEE findings: 

  • LVEF 45–50% 

  • Severe AI, mobile vegetations 

  • Aortic root abscess 

  • Left pleural effusion 

  • Complication: severe bronchospasm → ICU + ventilator

Postoperative Course

  • Extubated POD1 

  • Later underwent Bio-Bentall procedure 

  • Developed respiratory failure → VV-ECMO (POD1) 

  • Extubated POD4, decannulated POD8 

  • Gradual cardiac recovery → discharge to SNF

Clinical & Anesthetic Takeaways

  1. Acute severe AI ≠ chronic AI 

  • High risk for rapid decompensation in pregnancy 

  1. Aortic root abscess 

  • Rare but critical → risk of rupture with ↑ CO and aortic dilation 

  1. Anesthetic considerations 

  • Avoid afterload increase 

  • Maintain forward flow (inotropes often required) 

  • Be prepared for hemodynamic instability + possible respiratory failure

  1. Multidisciplinary care is critical 

  • Cardiology, cardiac surgery, MFM, anesthesia, ICU 

  1. Termination of pregnancy 

  • Should be early, patient-centered, and clearly discussed in previablehigh-risk cases

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