Anesthesia management of elderly woman suffering with severe mitral regurgitation, pulmonary artery hypertension, and severe left ventricular dysfunction scheduled for hemiarthoplasty

We present a case of an elderly woman aged 76 years suffering from severe mitral regurgitation, moderate tricuspid regurgitation, and moderate pulmonary hypertension associated with severe left ventricular dysfunction scheduled for right hemiarthoplasty. Hypertension and diabetes were associated comorbid factors. Patient had grade IV exertional dysponea. Patient was on cardiovascular treatment and nebulization therapy since 4 years. We opted for graded epidural anesthesia as an anesthetic technique of choice for the patient because of its intraoperative hemodynamic stability and postoperative analgesia. Graded epidural provides minimal effects on the contractility and heart rate providing ideal intraoperative conditions. We used ropivacaine as a local anesthetic for graded epidural anesthesia for its cardiovascular stability compared to other local anesthetics. This case highlights the advantage of graded epidural anesthesia over general anesthesia and spinal anesthesia in patients suffering from valvular heart disease, pulmonary artery hypertension, and severe left ventricular dysfunction.