A 2-month-old girl was admitted to the hospital due to “congenital heart disease, heart failure with shortness of breath.” Echocardiography suggested “ventricular septal defect (VSD), atrial septal defect (ASD), and severe pulmonary hypertension (PAH).” After admission, the child’s respiratory distress deteriorated. She underwent endotracheal intubation, mechanical ventilation, and supportive treatments such as anti-infection and diuresis and was then scheduled to undergo VSD and ASD repair under general anesthesia. This case was very challenging for anesthetic management due to the child’s young age, low weight, large defect size, severe PAH, and large intracardiac shunt. According to infants’ physiological and pathophysiological characteristics, adjusting the balance of systemic-pulmonary circulation resistance, rational use of positive inotropic drugs, and maintaining appropriate heart rate, myocardial contractility, and preload are the key points of anesthetic management in this case.