Severe aortic valvular disease can be treated with valve replacement using an autologous pulmonary valve, also known as the Ross procedure. In young females who wish to bear children in the future, the Ross procedure may be a preferable option over mechanical or bioprosthetic valve replacement, as it offers long-term durability without the need for life-long anticoagulation. However, it is not without complications. Herein, we present the successful perioperative anesthesia management of a patient with history of Ross procedure and mitral valve bioprosthesis, with subsequent development of severe aortic insufficiency and moderate mitral stenosis, who delivered a preterm infant via emergent Cesarean section. This case highlights the value of early identification of high-risk parturients, the benefit of early referral to anesthesia preoperative evaluation to establish an anesthetic plan, and the multidisciplinary involvement in the perioperative period.
