Managing pts with DVR, PPM, AF and HTN is a challenge to anesthesiologist because of risk due to endocarditis, bleeding, thromboembolism, malfunction of pacemaker and MI. Displacement of dental implant in paranasal sinus is not very rare but it primarily occurs in patient with severe pneumatization of maxillary sinus/or defect of alveolar process. The present case report highlights the anaesthetic management of a patient with double valve replacement (DVR), atrial fibrillation (AF) and permanent pacemaker (PPM) for misplaced dental implant in the paranasal sinuses. Successful non-cardiac surgeries in patients who have heart disease depends on good preoperative assessment, intraoperative and post-operative management.

Abbreviation: DVR: Double Valve Replacement AF: Atrial Fibrillation PPM: Permanent Pacemaker HT: Hypertension.