Infective endocarditis in pregnancy is associated with high maternal and fetal morbidity and mortality. Heart failure due to acute valve regurgitation is the most common indication for cardiac surgery for this group of patients. We report a 39-year old multigravida at 29 weeks AOG. She presented with dyspnea. She was diagnosed with severe multivalvular disease, rheumatic heart disease and infective endocarditis. Medical management was attempted, however on the 11th hospital day, due to hemodynamic instability and non-reassuring fetal status, cesarean section (CS) immediately followed by cardiopulmonary bypass was done. Mitral valve (MV) repair was converted to MV replacement by intra-operative decision. The decision for the management depended on the gestational age and the general status of our pregnant patient, which resulted in a favorable outcome.