ANESTHETIC MANAGEMENT OF A CASE OF VENTRAL HERNIA WITH SEVERE MITRAL STENOSIS WITH SEVERE PAH POSTED FOR HERNIOPLASTY

Introduction: Managing severe mitral stenosis in non-cardiac surgeries poses a signicant challenge for anesthesiologists. Both general and regional anesthesia present specic limitations. Mitral stenosis, the most frequent complication of rheumatic heart disease (RHD), requires careful anesthetic planning due to its associated complexities. Segmental epidural anesthesia, a neuraxial technique, offers effective anesthesia while minimizing excessive sympathetic blockade. 69-year-old female with a history of systemic hypertension and rheumatoid arth Case Report: ritis presented with a painful, gradually enlarging swelling in the right infra-umbilical region, which had been progressing for the past 20 years. She also reported intermittent episodes of breathlessness and palpitations over the last three years. Upon admission, she experienced severe breathlessness, with a METS score of 5.The cardiologist prescribed oral Torsemide (10 mg BD), Aldactone (25 mg OD), and Metoprolol (50 mg OD). The patient declined mitral valve replacement (MVR).On examination, her vital signs were stable. Auscultation revealed a low-pitched, rough, rumbling mid-diastolic murmur at the mitral area, a loud P2 in the pulmonary area, and a pan-systolic murmur over the tricuspid area. Abdominal examination identied a 6x4 cm non-reducible swelling, located 8 cm inferior and 5 cm lateral to the umbilicus on the right side. G Conclusion: raded epidural anaesthesia is a reliable technique for patients with low ejection fraction and valvular heart disease. Implementing a cautious and controlled epidural approach allows cardiac patients to undergo elective surgeries with improved safety and outcomes. This case emphasizes the advantages of graded epidural anaesthesia and highlights key perioperative considerations for managing patients with severe valvular conditions.