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Background and Aims Thoracic aorta aneurysms carry a risk of serious adverse events, including dissection, rupture and death. Aortic dissection is often associated with episodes of acute hypertension. Physical and emotional stress in the peripartum may increase this risk.Methods A 27-year-old patient was admitted for an elective caesarian section at 37 weeks of gestation. She had a diagnosis of ventricular septal defect without hemodynamically significant shunt, thoracic aorta aneurysm, obesity (BMI 46 kg/m2) and chronic arterial hypertension. Preoperative assessment indicated features of anticipated difficult airway, and an echocardiography revealed significant aortic root dilation of 50 mm (representing 8 mm increase during pregnancy). A multidisciplinary team proposed elective caesarian section as delivery route under epidural anesthesia.Results An arterial line was inserted before lumbar epidural catheter placement. Incremental epidural bolus totaling 10 mL ropivacaine 0.75% were administered to achieve and maintain surgical anesthesia, with minimal hemodynamic impact. Intermittent bolus of esmolol (total 100 mg) and labetalol (total 10 mg) were used to achieve heart rate and blood pressure control, and the patient had an uneventful intra-operative period. Post-operative labetalol infusion and invasive blood pressure (BP) monitoring took place in level II post-anesthesia recovery area for 48 h, with no adverse events. She was transferred to the ward and discharged home at 72 h.Conclusions Society guidelines have defined high-risk features for thoracic aorta aneurysms, of which the absolute diameter, growth rate and location of the aneurysm are some. Aortic root involvement, in particular, carries a higher risk of adverse events. This case presented a unique challenge regarding possible hypertensive surges in a patient with congenital cardiopathy that would benefit from avoidance of abrupt hemodynamic changes. Invasive BP monitoring and slowly titrated epidural anesthesia allowed for control of the sympathetic response of noxious stimuli while also maintaining hemodynamic stability, offering a valuable option in the management of these patients.