Introduction: Ventricular septal defect with pulmonary atresia (VSD-PA) is the most severe form of tetralogy of Fallot. We hereby report the successful utilisation of epidural volume extension (EVE) technique for hysterectomy in a lady with VSD-PA. Case-report: A 33-year old lady diagnosed with VSD-PA since infancy was scheduled for total abdominal hysterectomy for endometrial carcinoma. She had persistent cyanosis and progressively worsening dyspnea on exertion (NYHA Class 3).