Victor Eisenmenger’s initial definition of Eisenmengers syndrome was redefined by Wood as ‘the presence of high pulmonary vascular resistance associated with pulmonary artery hypertension at or close to systemic pressure associated with a reversed or bi–directional shunt at the aortopulmonary, interatrial or interventricular level‘. Survival beyond 50 years is unusual, but patients may lead a relatively active and productive life in early adulthood and will therefore present from time to time for noncardiac surgery. Though theoretical risks of anaesthesia are considerable patients are known to do well with a variety of techniques, if pathophysiology of the disease is well understood. We describe the anaesthetic management of the patient with Eisenmengers syndrome with abnormal uterine bleeding with multiple fibroids. She underwent a total abdominal hysterectomy after pre–operative stabilization. Anaesthetizing such a decompensated patient is an anaesthetic challenge