A 10-year-old boy who underwent ventricular septal defect repair 8 years ago was diagnosed with severe tricuspid regurgitation and was scheduled for tricuspid valvuloplasty surgery. The right heart was significantly enlarged due to long-term tricuspid regurgitation. Preoperative arrhythmia and right heart failure occurred. The risk of cardiac rupture and arrhythmia before the establishment of cardiopulmonary bypass during the secondary thoracotomy is significantly increased due to severe adhesion. The perioperative anesthetic management should focus on maintaining the hemodynamic stability, preventing the factors that worsen right heart function, and improving the right heart function.