Background: Patients with prosthetic heart valves are a challenge to any anesthesiologist due to the risk of infective endocarditis, bleeding and thrombosis. Case presentation: We present anesthetic management of a 58-year-old Indian lady with a prosthetic (mechanical) heart valve who underwent hemireplacement arthroplasty. Conclusion: Patients with prosthetic heart valves, especially those with the mechanical valves are prone for thrombosis and resultant complications if anticoagulation is not maintained properly. However, when they are scheduled for major surgery, they can be best managed by normalising the coagulation profile immediately prior to surgery and restarting the anticoagulation as early as possible.
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