IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 20, Issue 9 Ser.3 (September. 2021), PP 18-21 www.iosrjournals.org DOI: 10.9790/0853-2009031821 www.iosrjournal.org 18 | Page Anaesthetic Management in a Patient with a Bio- Prosthetic Heart Valve Posted For Anterior Colporrhaphy Dr Shefali Panjwani 1 Dr Amartya Chaudhuri 2 Dr Vinaya Kulkarni 3 1,2: Resident Doctor, Department of Anaesthesiology and Critical Care, BJGMC, Sassoon Hospital, Pune, Maharashtra, India 3: Associate Professor, Department of Anaesthesiology and Critical Care, BJGMC, Sassoon Hospital, Pune, Maharashtra, India Abstract BACKGROUND: Rheumatic Valvular Heart Disease (RVHD) is a systemic immune condition consequent to the beta-hemolytic streptococcal throat infection. It is an acquired heart disease. Single/ repeated attacks of rheumatic fever cause deformity of the heart valves, and over 20-30 years, may result in stenotic/ regurgitant valvular heart lesions. Prosthetic valve implants alleviate these patients. Patients with prosthetic valves project a specific challenge to the anesthesiologist due to the risk of thromboembolic events, bleeding and infective endocarditis. CASE PRESENTATION: A 56-years-old female, who had undergone Mitral valve replacement with a bio-core prosthetic valve five weeks ago, because of RVHD with severe Mitral Regurgitation (MR), was posted for 3rd-degree cystocele repair. The surgery was performed under combined epidural spinal anaesthesia. CONCLUSION: Regional anaesthesia provides intense analgesia, and hence plays an important role in the management of patients with heart disease undergoing surgery. These patients tend to tolerate regional anaesthesia well as long as adequate preloading is done and coronary artery perfusion is well maintained. We meticulously surveilled to avoid any increase in myocardial work and oxygen demand of the heart, and proper perioperative bridging therapy of anticoagulants was done. Keywords: Rheumatic Valvular Heart disease, Regional Anaesthesia, Epidural Anaesthesia, Mitral valve Replacement, Bridging therapy of anticoagulants. -------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 25-08-2021 Date of Acceptance: 09-09-2021 --------------------------------------------------------------------------------------------------------------------------------------- I. Background Rheumatic fever occurs as a consequence of a β hemolytic streptococcal throat infection 1,2 RVHD is a systemic immune condition 1 that occurs as a complication of rheumatic fever. It is an acquired heart disease. It is a leading cause of valvular heart disease in developing countries 3 . Single/ repeated attacks of rheumatic fever cause rigidity of the heart valves, making them deformed 1 . It causes shortening and fusion of chordae tendineae, and over 20-30 years may result in valvular stenosis or regurgitation. The Mitral valve is the most commonly affected. This case reports successful anaesthetic management of 3rd-degree cystocele repair in an RVHD patient who has undergone Mitral valve replacement five weeks ago for severe MR. II. Case Report 56-years-old female from India, weighing 62kg, ASA grade II, had chief complaints of urinary incontinence and dribbling of urine for the past seven years, associated with a small mass coming out of the vaginal orifice. She was posted for 3rd-degree cystocele repair by anterior colporrhaphy. Her past history revealed a history of New York Heart Association (NYHA) grade 3 breathlessness (refer to table 1 for NYHA Grades of breathlessness), palpitations, and two episodes of syncope four months ago when she was diagnosed with RVHD. She was also diagnosed with hypertension and diabetes mellitus on the same evaluation. Before she got operated on for MR, her preoperative two-dimensional echocardiography (2D Echo) was suggestive of Myxomatous mitral valve, severe MR, mild Tricuspid Regurgitation (TR), and mild Pulmonary Arterial Hypertension (PAH) with Left Ventricular Ejection Fraction (LVEF) 55%, Right Ventricular Systolic Pressure (RVSP) 33. Mitral valve replacement (MVR) with a bioprosthetic valve (BIOCOR-27), was performed for her RVHD five weeks ago. The patient was electively ventilated for two days after MVR and had an ICU stay of 6 days. She began the following medications at the time of discharge: Tab