Rheumatic  heart  disease  with  mild  Pulmonary Arterial Hypertension (PAH) in pregnancy is a grave situation, present with high maternal morbidity and mortality. In this case report, we describe the management of such a case which was even more difficult  in  combination  with  moderate  mitral  stenosis , mildpulmonary artery hypertension  and  with  grade 1  MR  with  trivial  TR.

 We successfully did this case  in  epidural anesthesia in situ in close monitoring of cardiac physicians .