PULMONARY VEIN (LEFT ATRIAL) ANASTOMOSIS - For right lung transplantation, develop the interatrial groove sharply in order to allow plancement of a vascular clamp across the recipient left atrium. A semb vascular clamp passed between the opened superior and inferior vein branch helps guild the atrial incision to maintain equal length of the posterior and anterior walls. Remove the recipient pulmonary vein staple lines or sutures and open the orifice to provide a continuous left atrail cuff for anastomosis (FIG5). Complete the anastomosis using a running 4-0 nonabsorbable monofilament suture (FIG6). A stay suture can be placed for orientation and to prevent purse-string narrowing of the completed anastomosis. If there is adequate atrial cuff, the “back wall” of the anastomosis is imbricated to avoid exposure of nonendothelialized tissue, which has the potential for developing left atrail thrombus. Leave the completed anastomosis untied for subsequent de-airing at the time of lung reperfusion. (FIG5) Preparation of the recipient pulmonary vein. (FIG6)