A 49-Year-Old Man With Acute Pulmonary Hypertension Post Lung Transplantation

49-year-old man with end-stage lung disease secondary to sarcoidosis had a past medical history significant for diabetes mellitus and Child A liver cirrhosis. He had successful preoperative evaluation for lung transplant 3 months before surgery. Intraoperatively, routine clamshell incision through the fourth intercostal space across the distal sternum was performed after complete general anesthesia and endotracheal intubation. Gross features of end-stage disease of both lungs due to sarcoidosis with mediastinal lymphadenopathy were evident. Right pneumonectomy was performed fi rst, and implantation of the cadaveric lung was performed after mobilization of the entire right lung. There was major discrepancy in the size of the donor and the recipient pulmonary arteries. Because of this, the vascular anastomosis was done between the pulmonary artery of the donor and the superior segmental branch of the right main pulmonary artery of the recipient. The anastomosis was carried out with 4-0 Prolene as a continuous suture, and the remaining part of the right main pulmonary artery was stapled. The right atrial cuff of the donor was anastomosed with the atrial cuff of the recipient using the 4-0 Prolene through everting mattress continuous suture, and two intercostal tubes were inserted. Because of the long duration of the right lung implantation, which was 10 h, the left lung transplantation was deferred because of prolonged ischemic time. Later, the patient had reperfusion, and the anterior chest wall incision