Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 08 29 1577 1577 Chhaya Suryawanshi Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Shefalika Sharma Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2026 03 25 2026 03 30 Worldwide, about 13% of the 200,000 annual recipients of prosthetic heart valves present for various non-cardiac surgical procedures When such cases present, both the anesthesiologist and the surgeon have to deal with the perioperative management of anticoagulation and a host of other issues involved and the potential for hemodynamic compromise. We report the perioperative management of a 65-year-old female with mechanical aortic and mitral valve prostheses, reduced ejection fraction, and pulmonary hypertension requiring cholecystectomy. Comprehensive preoperative optimization, anticoagulation bridging, meticulous perioperative monitoring, and cardiac-stable anesthetic techniques ensured an uneventful intraoperative and postoperative course. https://aacc.tums.ac.ir/index.php/aacc/article/view/1577