Cardiovascular disease represents a critical concern in pregnancy, increasingly contributing to maternal and fetal morbidity and mortality. This surge is attributed to older maternal ages and women with congenital heart disease reaching childbearing years, spotlighting the emergent field of Cardio-obstetrics. Physiological changes during pregnancy enhance cardiac workload, complicating pre-existing conditions or necessitating surgical interventions. While cardiovascular interventions are preferred to manage conditions non-invasively during pregnancy, cardiac surgery becomes indispensable when these fail and maternal life is at risk. This chapter explores the physiological cardiac adaptations during pregnancy, the indications for cardiac surgery, and the associated maternal and fetal outcomes. Conditions such as mitral stenosis, aortic stenosis, valve dysfunctions, and acute coronary syndromes are discussed with their respective management strategies. Emphasis is placed on the timing of interventions, highlighting the balance between advancing gestational age and maternal health risks. The 2018 European Society of Cardiology guidelines and recent studies suggest prioritizing non-surgical interventions but provide strategies for managing necessary cardiac surgeries during pregnancy. This chapter provides a comprehensive overview of managing cardiovascular diseases during pregnancy, integrating the latest research and guidelines to optimize both maternal and fetal outcomes.