Ruptured hepatic artery aneurysms (HAA) can lead to acute circulatory decompensation, which is usually fatal. Hence, HAAs must be identified and addressed rapidly to reduce the morbidity and mortality. Here, we report a 45-year-old female patient who was diagnosed with rheumatic heart disease, moderate mitral and aortic valve stenosis and regurgitation, and HAA. She underwent mitral and aortic valve replacements under cardiopulmonary bypass (CPB). At the end of the surgery, the patient’s blood pressure level plummeted, and abdominal distension was observed. An abdominal ultrasound suggested a ruptured HAA. After an emergency multidisciplinary consultation, selective hepatic arteriography through a right femoral artery approach and exploratory laparotomy were performed, which confirmed the diagnosis of ruptured HAA. After surgery, the patient was saved and stable. We reviewed the literature and found few reports of cases of heart valve surgery under CPB complicated by intraoperative HAA rupture. This case report shares our experience of anesthesia management in such cases.