Salvaging an accidental superior vena caval transection during a right pneumonectomy by creating a Glenn shunt: A case report and review of the literature

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Salvaging an accidental superior vena caval transection during a right pneumonectomy by creating a Glenn shunt: A case report and review of the literature Kallol Dasbaksi, MBBS, MS, MCh (CTVS), Kaushik Mukherjee, MBBS, MS, MCh (CTVS), Enakshi Saha, MBBS, MD (Anaesthesiology), Plaban Mukherjee, MBBS, MS, MCh (CTVS) The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 2, Pages e147-e149 (August 2014) DOI: 10.1016/j.jtcvs.2014.04.027 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A and B, Intraoperative photographs. C and D, Schematic diagrams. A and C, Vascular clamps were applied to the severed upper end of the superior vena cava (SVC; upper arrow). The horizontal lower arrow points toward the stump of the clamped right pulmonary artery (RPA) after pneumonectomy was completed. A right-angled Pacifico cannula was inserted into the upper stump of the superior vena cava, and a straight cannula was inserted into the right atrial (RA) appendage, maintaining superior vena caval flow to the right atrium. B and D, Completed end-to-end anastomosis between the upper end of the superior vena cava and the right pulmonary artery before removal of the superior vena caval cannula. The azygos vein is seen left intact. LPA, Left pulmonary artery; MPA, main pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 2014 148, e147-e149DOI: (10.1016/j.jtcvs.2014.04.027) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Postoperative images from the fourth postoperative year. A, Chest radiography showing opacity in the right hemithorax with dextroposed heart. B, Computed tomographic scan confirming the findings of chest radiography with a hyperinflated left lung. C, The cannula is in the right internal jugular vein (Int JUG), and passage of radiopaque contrast on superior vena caval (SVC) angiography into both the left pulmonary artery (LPA) and the azygos vein. D, Passage of contrast mainly into the azygos vein. E, Contrast in subsequent frames returning through the inferior vena cava (IVC) into the right atrium (RA), faintly opacifying these structures and the aorta. Some contrast is still present in the azygos vein. The Journal of Thoracic and Cardiovascular Surgery 2014 148, e147-e149DOI: (10.1016/j.jtcvs.2014.04.027) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions