A 27-year-old, G(3)P( 2)A(0) female with acute Staph aureus (SA) endocarditis successfully underwent CPB-assisted aortic valve replacement with a bioprosthetic aortic valve at 22 weeks' gestation. This patient's presentation of acute endocarditis complicated by septic shock, congestive heart failure, severe aortic insufficiency, multiple septic embolic events and borderline renal failure appeared on the daunting background of chronic heavy tobacco usage, hepatitis C positivity, long-term IV drug abuse and a pregnancy into its twenty-second week. Optimal treatment strategies implemented for both mother and fetus throughout the perioperative period contributed to a successful outcome for both.