Primary pulmonary hypertension is characterized by progressive increase in pulmonary vascular resistance leading to right ventricular (RV) failure and death. The desirable goal of primary pulmonary hypertension is preserving coronary perfusion of RV while decreasing pulmonary arterial pressure with selective pulmonary vasodilators. We report a case in which anesthetic management was successfully performed in a 67 years old man, who had experienced ventricular tachycardia at the previous anesthesia induction, with severe pulmonary hypertension and right ventricular dysfunction.