Perioperative management of poly-trauma in a postmitral valve replacement patient with severe left ventricular systolic dysfunction

The anesthetic management of a patient with severe left ventricular (LV) dysfunction undergoing noncardiac surgery poses a challenge to the anesthesiologist as LV dysfunction is commonly complicated by progressive congestive heart failure and malignant arrhythmias. When the cause for LV dysfunction is postvalve replacement, additional complications such as intraoperative thrombosis, bleeding, and infective endocarditis need to be addressed perioperatively. In such situations, the anesthesiologist must have the knowledge hemodynamics, diagnostic evaluations, and treatment modalities, more so regarding various drugs used during anesthesia. We report a case of postmitral valve replaced patient with severe LV dysfunction posted for surgery of fracture of the femur and facial fractures managed successfully during anesthesia.