Intraoperative Ventricular Ectopy Unmasking Undiagnosed Mitral Valve Prolapse During Total Abdominal Hysterectomy Under Regional Anaesthesia

Mitral valve prolapse (MVP) is a common valvular abnormality with a prevalence of approximately 2?3% in the general population. Although frequently benign and asymptomatic, MVP has been associated with ventricular arrhythmias in susceptible individuals. Routine preoperative evaluation may fail to detect clinically silent cases, posing potential intraoperative challenges. We report a case of a 43-year-old woman scheduled for elective total abdominal hysterectomy under combined spinal?epidural anaesthesia. Preoperative assessment, including electrocardiography, was unremarkable except for moderate anaemia. Shortly after administration of regional anaesthesia, frequent ventricular ectopic beats were observed on continuous electrocardiographic monitoring. The patient remained haemodynamically stable, and the surgical procedure was completed uneventfully. Postoperative transthoracic echocardiography revealed previously undiagnosed mitral valve prolapse. This case underscores the importance of vigilant intraoperative monitoring and consideration of underlying structural cardiac abnormalities when unexplained ventricular arrhythmias occur during regional anaesthesia.