Persistent left superior vena cava with partial anomalous venous return in a liver transplant patient.

Insertion of central venous catheters is commonly performed on critically ill patients. Successful placement requires knowledge of vascular anatomy, but vascular anomalies may pose difficulties during insertion and confirmation of catheter position. This report describes the incidental discovery of a persistent left superior vena cava emptying into a pulmonary vein with partial anomalous pulmonary venous return to the left innominate vein and ultimately into the right superior vena cava, after placement of a left internal jugular central line in a patient presenting for liver transplant. We discuss the clinical implications of persistent left superior vena cava and the steps we took to evaluate catheter position.

Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Failure in a Liver Transplant Patient: A Case Report.

Intraoperative extracorporeal membrane oxygenation (ECMO) support, both venoarterial and venovenous (VV), have been used sparingly and with limited success in the setting of liver transplantation. Here, we report the successful use of VV-ECMO in the resuscitation and pulmonary bridging support after severe systemic inflammatory response in a combined liver and kidney transplant recipient who suffered primary nonfunction of both allografts. Where conventional ventilator maneuvers may prove ineffective, the implementation of VV-ECMO should be considered as a therapeutic option in limited, short-lived acute pulmonary injury.