Thoracic Anaesthesia in a Patient with Mechanical Mitral Valve: A Case Report

Oesophageal diverticulum is a rare condition characterised by an outpouching of the oesophageal wall, often associated with dysphagia, regurgitation, and a risk of aspiration. Surgical resection, typically via thoracotomy, presents significant anaesthetic challenges, particularly in patients with pre-existing cardiac disease requiring One-lung Ventilation (OLV). Patients with Rheumatic Valvular Heart Disease (RVHD), Atrial Fibrillation (AF), and prosthetic mitral valves pose additional perioperative risks, including haemodynamic instability, anticoagulation management, and pulmonary complications. Hereby, the authors present case of a 49- year-old male with longstanding RVHD, Mitral Valve Replacement (MVR), and left ventricular systolic dysfunction (ejection fraction 35%) who presented with worsening dysphagia, regurgitation, and dyspnoea. Imaging confirmed a 50×49×86 mm oesophageal diverticulum with bilateral pleural effusion. Preoperative optimisation included anticoagulation management, rate control for AF, and pleural drainage. The patient underwent oesophageal diverticulectomy under general anaesthesia with a left-sided doublelumen tube and thoracic epidural analgesia. Intraoperative challenges included transient AF, hypotension requiring vasopressors and inotropes, and desaturation during OLV, all of which were managed with recruitment manoeuvres and apnoeic oxygenation. Postoperatively, anticoagulation was restarted, and the patient was extubated on day two without complications. The present case underscores the importance of meticulous perioperative planning, haemodynamic monitoring, and multidisciplinary coordination in managing complex cardiac patients undergoing thoracic surgery. A tailored anaesthetic approach focusing on oxygenation, cardiac stability, and balancing anticoagulation is crucial for optimal outcomes.