Perioperative anesthetic management of a combined right atrial thrombectomy with living donor liver transplantation.

Hepatocellular carcinoma (HCC) with vascular invasion is usually considered inoperable. We describe a case of HCC with vascular invasion and right atrial thrombus that was successfully down staged. Patient underwent combined right atrial thrombectomy and living donor liver transplantation (LDLT) in the same setting. Perioperative anesthesia management and perioperative concerns of two major combined procedures are discussed.