title: Anesthetic management of a patient with a double inferior vena cava and pulmonary alveolar proteinosis who underwent bilateral living-donor lobar lung transplantation.
abstract: A 43-year-old woman with pulmonary fibrosis secondary to pulmonary alveolar proteinosis was scheduled to undergo lung transplantation. Before the lung transplantation, she had undergone multiple whole-lung lavage procedures on extracorporeal circulation (ECC), which had caused scarring of the right femoral subcutaneous tissues. Preoperative examination revealed a double inferior vena cava (IVC) with interiliac communication, and the left IVC ended at the left renal vein. Surgical exposure of the right femoral vessels was performed immediately after anesthetic induction for emergent vascular access to establish an ECC. Cardiopulmonary collapse did not occur and the ECC was not required until lung resection. The lung transplantation was completed uneventfully. Congenital IVC anomaly is rare, but may make cannulation through the femoral vein difficult. Scarring of the subcutaneous tissue could result in a difficult "percutaneous" approach to the vessels. Evaluation of the vascular anatomy related to the establishment of an ECC is important before lung transplantation.
authors.affiliation: Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Murata
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hara
authors.forename: Shuhei
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Haruka
authors.initials: H
authors.lastname: Inoue
authors.forename: Hikoma
authors.initials: H
authors.lastname: Yamashita
authors.forename: Koji
authors.initials: K
authors.lastname: Sumikawa
mesh_terms: D000328:Adult; D000758:Anesthesia; D017548:Echocardiography, Transesophageal; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D010690:Phlebography; D011649:Pulmonary Alveolar Proteinosis / Q000601:surgery*; D012129:Respiratory Function Tests; D014682:Vena Cava, Inferior / Q000002:abnormalities*