KNOWLEDGE – International Journal Vol.34.4 September, 2019 921 FEBRILE CONDITION IN 23-YEAR OLD PREGNANT WOMAN Asen Ivanov “St. George” University Hospital – Plovdiv, Bulgaria, acevanov1988@gmail.com Todor Gonovski Medical University – Plovdiv, Bulgaria, Department of Cardiovascular Surgery tgonovski@yahoo.com Hristo Stoev Medical University – Plovdiv, Bulgaria, Department of Cardiovascular Surgery hristostoev87@gmail.com Abstract: A 23-year-old woman in her 29 th gestation week of pregnancy was admitted in Obstetrics and Gynaecology Department with symptoms of fever, dyspnea and shortness of breath. The blood test examinations showed significant leukocytosis and elevated c-reactive protein levels. Transthoracic(TT) echocardiography was performed showing severe mitral valve regurgitation with posterior cusp destruction confirming the diagnosis of infective endocarditis. The condition of the patient significantly deteriorated, and she was urgently transferred to the Cardiovascular Surgery Department for an emergent surgical treatment. She was admitted in the Intensive Care Unit with clinical signs of severe septic shock and severe left heart insufficiency. A consultation of gynaecologist was performed and fetal death in utero from fetal ultrasonography was diagnosed. A decision for an emergent simultaneous operation was taken. During the anesthesia induction the patient developed severe circulatory shock needing a cardiopulmonary resuscitation which restored the spontaneous circulation after one minute. At first, before heparinization sectio parva was performed confirming the diagnosis of fetal death. During the cardiac operation after the cardiopulmonary bypass(CPB) institution, mitral valve replacement and inspection of the tricuspid valve was performed. The CPB was discontinued with three catecholamine support. In the postoperative period she was febrile with severe multiple organ system failure(MOSF) manifestation, generalized single tonic- clonic seizure and in the following hours three seizures with focal onset(muscle contractions in the right facial half) were observed. On the postoperative day(POD) 2 she developed clinical signs of blue discoloration of the distal phalanx of the left foot. Doppler ultrasound examination showed subtle pulsations on the left dorsal pedal artery. Ultrahemofiltration with antiseptic filter was performed for cytokine removal. In the following days the condition of the patient improved. She was extubated on POD 4, transferred to the post-operative department on POD 7 and discharged on POD 23. Despite advances in medicine, the treatment of the infective endocarditis is associated with high mortality and complication rates. Multidisciplinary collaboration is crucial for achieving the best outcome. Keywords: Infective endocarditis, pregnancy, cardiac surgery, mitral valve replacement. CASE PRESENTATION We present a case of 23-year-old woman in 29 th gestation week of her second pregnancy admitted in Obstetrics and Gynaecology Department with four weeks history of intermittent fever, dyspnea and shortness of breath. She has one previous healthy term pregnancy without any complications. On admission the laboratory test examinations(Table 1) showed significant leukocytosis and elevated c-reactive protein levels. Hemoglobin 137 g/l Hematocrit 0.40 L/l Erythrocytes 4.73 g/l Leucocytes 28.5 g/l Platelets 204 G/l Total cholesterol 3.7 mmol/l Triglycerides 1.03 mmol/l Total protein 79 g/l Albumin 42 g/l Creatinine 96 μmol/l Urea 5 μmol/l Total bilirubin 19.9 μmol/l Protrombin time 77.9 % Fibrinogen 4.7 g/l Glucose 9.8 mmol/l Table 1: Laboratory test results;