Managing multiple valvular disease in spine surgery: A case report

Multiple valvular heart disease can pose significant anesthetic challenges, with each lesion imposing unique hemodynamic implications. This case report describes the peri-operative management of a patient with combined severe aortic and mitral stenosis undergoing urgent spinal surgery in the prone position. Both stenotic aortic and mitral lesions can individually limit cardiac output by limiting left ventricular filling and causing left ventricular outflow tract obstruction. The co-existence of both lesions can worsen hemodynamic frailty. The prone position further complicates this by reducing venous return and pre-load, necessitating meticulous hemodynamic control. Our anesthetic management was carefully tailored to meet specific hemodynamic goals, focusing on optimising pre-load, maintaining systemic vascular resistance, and ensuring stable cardiac output. A goal-directed approach using advanced monitoring techniques enabled precise titration of anesthetic agents, vasopressors, and fluid to achieve targeted perioperative hemodynamic goals. This case highlights the importance of individualised, goal-directed hemodynamic strategies in managing high-risk patients with multiple valvular disease undergoing non-cardiac surgery.