Perioperative care of non-cardiac surgery patients with prosthetic heart valves undergoes anesthetic care that is quite challenging because of the competing interests of thromboembolism and bleeding. We present an anesthetic control of a 65-year-old female patient with a metallic mitral valve prosthesis and atrial fibrillation undergoing biopsy and resection of a right femoral mass. The patient had been under chronic warfarin treatment. The warfarin was stopped four days before surgery and bridging heparin with low molecular weight heparin (LMWH) was initiated. LMWH was given as the last dose six hours before surgery. Preoperative coagulation test was 1.3 INR. The general anesthesia was used with invasive monitoring of the arterial blood pressure. Midazolam, nalbuphine, propofol were used to induce, which was followed by atracurium that had to block neuromuscular activity. IGEL supraglottic airway device was used to secure the airway. Metoprolol was used to achieve intraoperative heart rate control. The estimated blood loss was 700 ml and it was corrected using crystalloid infusion. LMWH was initiated in the evening of the surgery after the operation, and warfarin therapy was recalled in the morning of the next day with the monitoring of coagulation parameters on a daily basis. Postoperative echocardiography revealed the presence of normal functioning prosthetic valve, free of thrombus. The patient did not experience any thromboembolic or bleeding disease and was discharged on the tenth postoperative day. This case illustrates the necessity of close perioperative anticoagulation, hemodynamic stability and infection prophylaxis in patients with mechanical heart valves that have undergone non cardiac surgery.