Open Heart Dual Valve Surgery Without Blood Transfusion: A Case Report

In Nepal, rheumatic heart disease (RHD) is alarmingly prevalent, marked by presentations like migratory joint arthritis, carditis, subcutaneous nodules, erythema marginatum, and Sydenham chorea. This condition can progress to instigate valvular defects. Although these patients are first approached medically, they may require surgery for severe cases. Refusal for blood transfusion might not be a major issue for other general surgeries; however, in cardiac surgery, where there is massive blood loss, it's quite a challenge. This challenge becomes even more pronounced in a developing country that lacks advanced facilities like a cell saver for autotransfusion. Herein, we report a case of a 22-year-old female, a Jehovah's Witness, suffering from RHD, severe mitral regurgitation, severe tricuspid regurgitation, and severe pulmonary artery hypertension. She underwent mitral valve replacement and tricuspid repair surgery (modified DeVega) by avoiding any form of blood product transfusion.