Perioperative management of polytrauma in a post MVR patient with severe left ventricular systolic dysfunction

The anesthetic management of a patient with severe left ventricular dysfunction undergoing non cardiac surgery is a challenging task, as left ventricular systolic dysfunction (LVSD) is commonly complicated by progressive congestive heart failure and malignant arrhythmias. When the cause for LVSD is post valve replacement, additional complications like intraoperative thrombosis, bleeding and infective endocarditis need to be addressed peri-operatively. In such situations, the anesthesiologist must have the knowledge of hemodynamic changes, diagnostic and treatment modalities, as well as various drugs used during anesthesia. We report a case of post mitral valve replaced patient with severe LVSD posted for surgery of fracture of femur and facial fractures managed successfully during anesthesia.