Background <p>Anesthesia management for patients with uncorrected univentricular heart and ectopic pregnancy undergoing emergency laparotomy presents significant challenges. Close collaboration among a multidisciplinary team, a keen understanding of anatomy and pathophysiology, and optimization of intraoperative hemodynamic targets are crucial for successful outcomes.</p> Case presentation <p>We report the anesthetic challenges encountered in a case of an adult female with uncorrected univentricular heart and ectopic pregnancy who required urgent exploratory laparotomy. We summarize critical anesthetic considerations for patients with univentricular heart physiology undergoing non-cardiac surgery. The patient successfully underwent unilateral salpingectomy under general anesthesia.</p> Conclusions <p>Multidisciplinary coordination and tailored hemodynamic management were pivotal to successful outcomes, providing valuable reference for the clinical diagnosis and treatment of similar cases in the future.</p>