Phenylephrine or norepineph- rine can be used to increase blood pressure in patients with no significant CAD.9,10 In case of systemic hypertension, arterial dilators, such as short-acting calcium channel blockers, are pre- ferred. Epidural or spinal anesthetic interven- tions should be modified to avoid rapid changes in systemic pressure, using only high-dilution neuraxial local anesthetic agents in combination 2. In asymptomatic patients with moderate or greater degrees of rheumatic MS with a pul- monary artery systolic pressure <50 mm Hg, elevated-risk noncardiac surgery can be per- formed with invasive hemodynamic monitoring to optimize loading conditions. Maintenance of LV preload and sinus rhythm should be the targets in the perioperative period. Preload should be maintained at a level high enough to allow an adequate forward cardiac output across the stenotic mitral valve but low enough to avoid pulmonary edema. Preload attain- ment can be challenging and requires mea- surement of cardiac output and pulmonary wedge pressure. Of particular concern is judi- cious intravenous fluid administration, so as to avoid increases in the LA pressure and pul- monary capillary pressure that may precipitate CLINICAL STATEMENTS AND GUIDELINES acute pulmonary edema. Tachycardia should be avoided because of the shortened diastolic LV filling time across the stenotic mitral valve, resulting in an increase in LA pressure.15 17 In asymptomatic patients with significant rheu- matic MS and with a pulmonary artery systolic pressure >50 mm Hg, the risk of elective inter- mediate- to high-risk noncardiac surgery is considerably higher, so these patients should be evaluated and treated as outlined in the rheumatic MS section (Section 6.2).6,7,18 3. 