Abstract

Introduction : The most forms of valvular heart disease produce pressure overload (mitral stenosis, aortic stenosis) or volume overload (mitral regurgitation, aortic regurgitation). The net effect of valvular heart disease is interference with forward flow of blood from the heart into the systemic circulation. Selection of anesthetic drugs and neuromuscular blocking drugs for patients with valvular heart disease is often based on the likely effects of drug-induced changes in cardiac rhythm, HR,SBP,SVR and PVR relative to maintenance of cardiac output in these patients.Patients with valvular heart disease should receive appropriate antibiotics in the perioperative period for protection against infective endocarditis.

Case report:A50year old man was admitted forboutonnier deformity of left little finger.He was chronic smoker with COPD and was a known case of rheumatic heart diseasesince 20yrs onTab.metoprolol 25mg&inj.penicillin every 21st day. Bilateral rhonchi and crepetation were present on auscultation.Hematological,biochemical & coagulation profilewere normal.Patient’sChest x Ray showedcardiomegaly and ECG had Q, T wave & ST segment changes.His echocardiography revealed RHD with mild MS trivial MR,moderate AS, AR, dilated LA,EF 66%. Patient was administered supraclavicular block and ECG,NIBP,SPO2was monitored.Perioperative management was uneventful.

Conclusion : Cardiac output in RHD is usuallylow and barely maintained by increased filling pressuresand tachycardia. Drugs and techniques that cause decreasedvenous return, bradycardia or decreased contractility to be avoided.