Redo cardiac valve surgery is technically challenging and carries a high operative risk. Anaesthesia for combination of redo cardiac valve surgery with severe kyphoscoliosis is a rare co-incidence and is associated with high morbidity and mortality. We report our anaesthetic challenges for a redo cardiac valve surgery in a 39-year-old female having rheumatic mitral and aoric valve disease with severe kyphoscoliosis. she had a difficult airway and severe restrictive pulmonary disease with poor respiratory reserve. Futhermore, redo surgery also added difficulty on this. Proper pre-op evaluation and prior planning to handle the anticipated problems helped in the successful outcome.