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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and Aims Patients with transposition of the great vessels (TGV) corrected by the Senning procedure present significant anesthetic challenges during pregnancy due to altered cardiovascular physiology and increased risk of hemodynamic instability. Effective anesthetic management aims to minimize cardiac stress and avoid acute hemodynamic shifts. This case highlights the efficacy and safety of incremental epidural anesthesia as a tailored regional anesthesia technique in this high-risk obstetric population.Methods A 29-year-old pregnant patient with Senning-corrected TGV, right ventricular dilation, severe aortic insufficiency, and right pulmonary vein stenosis underwent elective cesarean section. Given the high WHO morbidity/mortality risk (20–30%), a multidisciplinary team devised an anesthetic plan emphasizing gradual regional anesthesia. After invasive arterial monitoring and a preload of 500 mL crystalloid, epidural anesthesia was performed at L1/L2 using incremental boluses of 0.75% ropivacaine (4 mL per bolus, total 16 mL) administered over 25 minutes.Results Incremental epidural anesthesia successfully prevented acute hemodynamic fluctuations, maintaining stable intraoperative vitals. Phenylephrine (150 mcg) provided minimal vasopressor support. The procedure proceeded uneventfully, with no perioperative complications. Postoperatively, the patient was closely monitored in a Level 2 ICU before transfer to a general ward, experiencing an uncomplicated recovery.Conclusions Incremental epidural anesthesia is a safe and effective regional anesthetic technique for managing elective cesarean delivery in patients with complex congenital heart disease corrected by Senning procedure. This individualized approach significantly minimizes cardiovascular stress and volume shifts, optimizing maternal-fetal outcomes in high-risk obstetric populations.