[Abstract] For preoperative patients with severely reduced cardiac ejection fraction (EF%) and abnormal increase of B-type natriuretic peptide precursor (NT-proBNP), it is usually necessary to postpone the operation and consult a cardiologist to optimize treatment until the patient has no obvious heart failure symptoms. Elective surgery should be performed after symptoms are controlled to further improve perioperative safety for these patients. We report a patient with severe EF decrease (21%) and abnormal increase in NT-proBNP (19700.00 pg/ml). After multi-disciplinary treatment and meticulous anesthesia management, the operation was successfully completed and the patient recovered smoothly and was discharged from the hospital.We now summarize this case to provide a reference for anesthesia and perioperative management of such patients.