Anesthetic management of a patient with a double inferior vena cava and pulmonary alveolar proteinosis who underwent bilateral living-donor lobar lung transplantation.

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

In situ Replacement of Mycotic Thoracoabdominal Aortic Aneurysm Using Expanded-polytetrafluoroethylene Graft With Omental Flap

AbstractA mycotic aneurysm of the thoracoabdominal aorta was detected in a 68-year-old male after 1 month of antibiotic therapy for acute enteritis. The infected aorta was resected and revascularized via in situ grafting using an expanded-polytetrafluoroethylene graft with reconstruction of the visceral arteries. The implanted graft was covered with an omental flap. The patient was discharged 39 days after the operation. This procedure may help prevent postoperative graft infection and improve the surgical outcome in mycotic aneurysms

“Twin Icicle” Calcifications Cause Aortic Annular Rupture

Aortic annular rupture is a potentially fatal complication after transcatheter aortic valve implantation with high mortality. Although it is quite rare and difficult to identify the mechanisms and predictors, prosthesis oversizing and massive calcification of the aortic annulus are thought to be a potential risk of this complication. A case presented here is an aortic annular rupture after transcatheter aortic valve implantation. Although the valve was not oversized, there were 2 severe calcifications of aortic annulus at nearby areas like “twin icicles,” thought to be a trigger of this potentially fatal complication.No Full Tex