Pheochromocytoma is an uncommon neuroectodermic tumour of adrenal medulla. Additional cardiac problems malta anaesthesia management of pheochromocytoma more complicated. We aimed to present the anaesthetic management of pheochromocytoma patient with aortic valve insufficiency (AVI). A 45 years-old, 6.5 kg, female patient with third degree of AVI was admitted for pheochromocytoma surgery. Before surgery, she was pre-treated with phenoxybenzamine and nicardipine for a week. In the operation room, thoracic epidural analgesia was maintained with 10 mL 0.5 % bupivacaine loading dose, followed by 5 mL 0.5 % bupivacaine for every hour during surgery. Then anaesthesia ivas induced with midazolum, droperidol, fentanyl, vecuronium, metoprolol and lidocaine. High dose fenlanyl anaesthesia ivith 0.5-1.5 % isoflurane were preferred for maintenance of anaesthesia. Haemodynamic stability was obtained with this anaesthesia management with lower dose vasodilators until, tlie resection of adrenal mass. After the resection, severe hypotension was controlled with inotropic agents. Surgery was completed uneventfully and patient was transferred to ICU. In phaeochromoytoma cases with. AVI, we think that appropriate (uiuesthetic approach is the thoracal epidural analgesia and high dose fentanyl anaesthesia with support of vasodilatators or vasoactive agents.