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Anaesthetising patients with primary pulmonary hypertension presents a complex problem and there are few case reports 1 ,2 in the literature for guidance. CASE REPORT A 45-year-old woman weighing 64 kg was scheduled for repair of her right femoral artery aneurysm. Approximately 12 months prior to admission she had sought treatment for increasing shortness of breath. At that time she had cyanosis and signs of right-sided cardiac failure. Investigations at that time, including cardiac catheterisation, confirmed that she had pulmonary hypertension with secondary tricuspid incompetence. No cause was found for the pulmonary hypertension so the diagnosis of primary pulmonary hypertension was made. However, she was treated with warfarin because the possibility of recurrent pulmonary emboli could not be excluded. Following her cardiac catheter a lump developed in her right groin and she complained of pain in her right leg. The lump in the groin had increased in size recently and her leg pain was considered to be ischaemic in origin. At the time of this admission she also complained of marked shortness of breath on minimal exertion. On examination the patient had central cyanosis and signs of right ventricular hypertrophy and tricuspid incompetence. She had 5 cm of pulsatile liver below the right costal margin and pitting oedema of her ankles. The mass in her groin measured 5 cm x 3 cm and was non-pulsatile. Chest X-ray showed *F.

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