Days from admission	Patient’s clinical course
1	Thirty-one-year-old woman at 26 weeks gestation with severe pulmonary hypertension secondary to rheumatic mitral stenosis presented for management of a pregnancy complicated by placenta accreta spectrum disorder.
2	Pulmonary artery catheterization demonstrated severely elevated filling pressures. She did not tolerate medical therapy. The cardio-obstetrics team met with the patient and her partner to determine next steps.
3	Brought to the operating room (OR) for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) supported caesarean delivery and hysterectomy. Extubated in the OR. Her infant was taken to the Neonatal Intensive Care Unit for further management.
6	Returned to the OR for surgical aortic and mitral valve replacement and tricuspid valve annuloplasty. Decannulated from ECMO in the OR.
7	Extubated
19	Discharged home from the hospital
Follow-up	At 30 days from the date of admission, the patient was doing well at home with her family. Her infant, who was born at 25 weeks 6 days, was discharged from the hospital at postmenstrual age 38 weeks 5 days.