Inclusion Criteria:  patients undergoing rheumatic valve replacement surgery elective surgery age between 18 and 80 years old left ventricular ejection fraction > 0.4  Exclusion Criteria:  Emergency and Re do surgery, Positive base line CTnI or CK-MB, Preoperative treatment with intralipid in the last 1 month. History of allergy to (peanut, eggs, and soya bean) Implanted pacemaker, previous myocardial infarction, Diabetic or other metabolic disorders, Significant Renal impairment (Cr > 1.5) or on hemodialysis Significant hepatic dysfunction (INR>2) Drugs interfere as (cyclosporine) Infection (WBC >12)