A-57-year-old woman with Eisenmenger’s syndrome due to ASD was underwent cystoscopic biopsy and ureteroscopy under general anesthesia. The patient had been treated with warfarin, PDE 5 inhibitor, endothelin receptor antagonist, and PGI2. The patient was NHYA class 3 due to hypoxemia (SpO2 75% with O2 3 L/min) and right heart failure. Pulmonary vascular resistance revealed very little, if any, response to either one or combination of oxygen and nitric oxide inhalation. To maintain systemic vascular resistance and venous return, general anesthesia was performed with spontaneous breathing using laryngeal mask airway. The perioperative hemodynamics including right-to-left shunt balance was maintained. In anesthetic management in an adult patient with Eisenmenger’s syndrome, general anesthesia with laryngeal mask airway, which can maintain spontaneous ventilation, can be a useful option.