Patients with valvular heart diseases are a challenge to anesthesiologists. A complete understanding of pathophysiology of valvular lesions is necessary for planning anesthesia and perioperative management for such patients. Here, we report successful anaesthetic management of a 36year old patient with previously diagnosed Rheumatic valvular heart disease (severe mitral stenosis with aortic stenosis) undergoing right sided inguinal mesh hernioplasty. In such patients, Ilioinguinal and Iliohypogastric nerve block offer an excellent alternative to neuraxial blockade and general anaesthesia.