Anaesthetic management of epidermoid cyst in a patient with balloon mitral valvuloplasty

Rheumatic Heart Disease is the commonest cause of mitral stenosis in developing countries. It is anautoimmune reactions to infection with group A Beta hemolytic streptococci which leads to scarring, calcification and thickening of mitral leaflets, commissural fusion causing significant decrease in valve area. Mitral stenosis is characterised by mechanical obstruction to left ventricular diastolic filling secondary to a progressive decrease in the size of mitral valve orifice. This valvular obstruction produces an increase in left atrial volume and pressure. Increases left atrial pressure can be transmitted to pulmonary vasculature leading to pulmonary edema and decreased pulmonary compliance. In mild mitral stenosis, the left ventricular filling and stroke volume are maintained at rest by an increase in left atrial pressure. However, stroke volume will decrease during stress induces tachycardia or when effective atrial contractions are lost as in atrial fibrillation. Such patients pose a challenge to the anaesthesiologists when they present for any non cardiac surgery. Anaesthesia and surgical blood loss, along with major fluid shifts is poorly tolerated by such patients. This can precipitate acute pulmonary edema, significant fall in blood pressure, atrial fibrillation, arrhythmias and thromboembolism. Here we discuss about anaesthetic management in a patient of epidermoid cyst, previously operated for balloon mitral valvuloplasty for mitral stenosis.