Attempted venous cannulation with a dual-stage cannula for cardiopulmonary bypass in routine coronary revascularization led to the discovery of an abnormal inferior vena cava in a 65-year-old patient. The operative and postoperative course of the patient were not affected by the inferior caval anomaly. The detailed infradiaphragmatic venous anatomy was elucidated later by MRI and showed bilateral inferior caval veins with azygos continuation. Although this malformation of the inferior cava is rare in adults, the occurrence should be known. Quick recognition and handling should be achieved if detected during cannulation for cardiopulmonary bypass.

Because of the paucity of literature reports about cardiac operations in renal-transplant patients we performed a retrospective study encompassing all such patients operated upon in our institution in 1993 and 1994. During this time 5 renal transplant patients underwent cardiac surgical procedures between 1 and 9 years after transplantation: in 4 patients coronary artery bypass grafting (CABG) was carried out and in one patient aortic valve replacement. We analyzed pre-, peri-, and postoperative data. Late results were obtained by questionnaire from the patients' primary physicians. Short- and long-term results were excellent. Mortality was 0%. At late follow-up (8-23 months) all patients were in NYHA class II or better. Postoperatively all patients experienced a clear improvement of their cardiac symptoms. None of the transplanted kidneys deteriorated. One patient who had to undergo intermittent hemodialysis preoperatively improved so much that she did not require any dialysis postoperatively. Although the total number of patients in this study is limited we believe it can be stated that renal transplant patients can undergo cardiac operations with generally good results.