Introduction: The management of caesarean sections in women with heart disease in resource-limited countries is a major challenge. Lack of infrastructure, poor access to specialized care and socio-cultural barriers worsens the maternal-foetal prognosis. Objective: To describe our experience of anaesthesiologic management of caesarean sections in parturient with heart disease, identifying the difficulties encountered and prognostic factors. Patients and Methods: Cross-sectional, descriptive and analytical study conducted prospectively over one year (January-December 2023). All parturient with cardiac disease referred for scheduled or emergency caesarean section were included. Results: Of 397 caesarean sections, 32 (8.06%) involved parturient with heart disease. The average age was 29 years. Cardiac diseases included rheumatic valvular disease (53.1%), congenital heart disease (21.9%), peripartum cardiomyopathy (15.6%) and coronary artery disease (9.4%). Previous cardiac surgery had been performed in 25% of patients. Of those on curative anticoagulation, only 18% had adequate compliance. Antenatal consultations were well attended by 43.8% of patients. At preoperative assessment, 68.8% were dyspneic, with a mean PAPS of 47 mmHg. Caesarean section was planned in 50% of cases. General anesthesia was preferred in 53.1% of cases. Intraoperative complications included cardiogenic shock (31.3%), cardiac arrest (9.4%, 3 cases) and neonatal resuscitation in 28.1% of cases. The maternal mortality rate was 21.9%. Conclusion: Heart disease in pregnancy remains associated with high morbidity and mortality in low-resource settings, with rheumatic valve disease being the most frequent. Delayed surgical management favors the development of severe pulmonary hypertension, complicating obstetrical management. Better therapeutic education, reinforced prenatal follow-up and wider access to cardiac surgery could improve maternal-fetal prognosis.