Only 15-25% of congenital heart disease patients survive into adulthood. Approximately 90% of these children survive to adulthood due to Advances in prenatal diagnosis, interventional cardiology; pediatric cardiac surgery, anesthesia, and critical care have resulted in survival of Eisenmenger syndrome. Eisenmenger syndrome is defined as the process in which a left to right shunt caused by a congenital heart defect in the fetal heart causes increased flow through the pulmonary vasculature, causing pulmonary hypertension, which in turn causes increased pressures in the right side of the heart, and reversal of the shunt into a right. Eisenmenger syndrome is a cyanotic heart defect characterized by a long-standing intracardiac shunt (caused by ventricular septal defect, atrial septal defect, or less commonly, patent ductus arteriosus. The long term survival of patients of Eisenmenger syndrome will make challenge for anesthetist; the risk during anesthesia of Eisenmenger syndrome may be increased. Combination of anesthetic considerations of Eisenmenger syndrome and anesthetic management of elderly patients must be considered. In Eisenmenger syndrome there is pulmonary hypertension lung congestion and increase risk of pneumonia. In elderly non cardiac patients there is increased risk of COPD, pneumonia; sleep apnea conduction abnormalities, bradyarrythmias and hypertension are very common among the elderly, Decreased renal blood flow and kidney mass decrease with age with Increased risk of renal impairment due to long standing Eisenmenger syndrome. This book contains the practical anesthetic considerations for anesthesia elderly Eisenmenger syndrome.