Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 07 13 1624 1624 Hannah May Ona Department of Anesthesiology, Philippine General Hospital, University of the Philippines, Manila, Philippines. Carlo Monteblanco Department of Anesthesiology, Philippine General Hospital, University of the Philippines, Manila, Philippines. Vidal Esguerra Department of Anesthesiology, Philippine General Hospital, University of the Philippines, Manila, Philippines. 2026 04 29 2026 05 23 Valvular heart disease is a significant clinical factor associated with elevated perioperative cardiovascular risk. Current literature offers limited guidance on managing severe valvular heart disease in non-cardiac emergency surgeries. In this report, a 61-year-old male with sigmoid adenocarcinoma presents with hemodynamic instability due to partial gut obstruction, complicated by severe aortic and mitral stenoses from rheumatic heart disease. Echocardiography, electrocardiography, and blood tests were employed for preoperative planning. Emergency open abdominal surgery was done under combined regional and general anesthesia, employing techniques that maintained adequate preload and avoided heart rate extremes. Patient tolerated the procedure and the immediate postoperative course. In this case, anesthetic management incorporating effective fluid management, careful hemodynamic monitoring, and maintaining cardiac output is crucial in preventing acute cardiac decompensation. https://aacc.tums.ac.ir/index.php/aacc/article/view/1624