ABSTRACT : A case of prosthetic mitral valve on anticoagulants with chronic AF presents a great preoperative, intraoperative and postoperative challenge to an anesthetist due to risks involved such as infective endocarditis, thromboembolism, life threatening arrhythmias and excessive bleeding .

METHODS : We are presenting a case report of 48 year old female with prosthetic mitral valve on oral anticoagulants with chronic AF who underwent exploratory laparotomy for lump in abdomen managed successfully under epidural anesthesia.

RESULTS : This case was managed successfully under epidural anesthesia without any complications.

CONCLUSIONS : Patients with prosthetic mitral heart valve with chronic AF when posted for major surgery can be managed uneventfully if proper precautions are taken. Warfarin should be changed to unfractionated heparin 4-5 days prior to surgery. INR should be maintained < 1.5 for proceeding with surgery. To prevent possible bleeding problems and to administer neuraxial block heparin should be discontinued 6 h prior to surgery and restarted within 6-12 h after surgery. Infective endocarditis prophylaxis should be given to all patients with prosthetic heart valve. Antiarrhythmic drugs and defibrillator should be kept ready.