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Indian Journal of Anesthesia and Analgesia

Volume  8, Issue 1, Jan-feb 2021, Pages 129-131

 

Case Report

Perioperative Management of a Patient with Prosthetic Mitral Valve Posted for Ankle Surgery
G N S Sravanthi1, Ravi Madhusudhana2
1Post Graduate Resident, 2Professor and HOD, Department of Anaesthesiology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka 563101, India.
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1Post Graduate Resident, 2Professor and HOD, Department of Anaesthesiology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka 563101, India.

Abstract

Introduction: Patients with prosthetic valves pose a specific challenge to the anesthesiologist due to their increased predisposition to thrombo embolic events, infective endocarditis and hemolysis. Case Report: Here we describe the anaesthetic management of a 50 year old female with prosthetic mitral valve posted for wound debridement and external fixation for open type III right ankle bone fracture. She is a known case of Rheumatic heart disease and has underwent mitral valve replacement with tricuspid annuloplasty 5years back and is on oral anticoagualtion which was stopped 7days prior to surgery. Pre operative ECG showed AF with recent ECHO finding of concentric LVH with EF of 60%. Pre operative coagulation profile was normal. Antibiotic prophylaxis was given 2hours prior to incision. Case was done under general anaesthesia. Patient was induced with etomidate and maintained with intermittent doses of propofol and isoflurane with adequate analgesics. Intra operative blood loss was around 100ml.Patient was extubated and shifted to ICU for observation. Conclusion: In patients with prosthetic heart valves the most common complication is thromboembolism therefore optimising the coagulation profile before the surgery and subsequent restarting of anticoagulation therapy immediately after surgery is of utmost importance.


Corresponding Author : G N S Sravanthi1,