Harvesting a Lung with Anomalous Pulmonary Vein Drainage

Harvesting a lung with an anomalous right-sided pulmonary vein connection presents unique anatomical and technical challenges requiring meticulous preoperative planning and intraoperative precision. In such cases - typically variants of partial anomalous pulmonary venous connection (PAPVC) - one or more pulmonary veins drain into the systemic venous circulation, most commonly the superior vena cava or right atrium, instead of the left atrium. During procurement, it is critical to identify all venous connections through preoperative imaging and intraoperative dissection to ensure complete preservation and accurate reconstruction. The surgeon must carefully isolate and preserve the anomalous vein with an adequate cuff of the systemic vessel or atrial tissue to facilitate anastomosis in the recipient. Failure to account for these anomalous connections may result in venous outflow obstruction or inadequate oxygenation post-transplant. Therefore, the procurement requires not only a thorough understanding of pulmonary venous anatomy but also close coordination with the transplant team to ensure successful reconstruction and function of the graft.