Common Femoral Vein Doppler as an Adjunct for Serial Assessment of Right Ventricular Dysfunction After Lung Transplantation

Right ventricular dysfunction complicates the early course after lung transplantation, particularly when primary graft dysfunction elevates pulmonary vascular resistance. Bedside assessment is challenging: transthoracic echocardiographic windows are often limited after clamshell thoracotomy, and pulmonary artery catheters are typically removed within days. Common femoral vein (CFV) Doppler offers a noninvasive, position-independent means of detecting venous congestion via peripheral venous waveform pulsatility. We describe a bedside protocol integrating serial CFV Doppler with echocardiography and invasive hemodynamics for postoperative right ventricular assessment, illustrated in a 77-year-old lung transplant recipient with pre-existing right ventricular dysfunction and primary graft dysfunction requiring venovenous extracorporeal membrane oxygenation (ECMO). Markedly abnormal bidirectional CFV Doppler waveforms were concordant with invasive evidence of venous congestion and progressively normalized in parallel with hemodynamic recovery, ECMO decannulation, and clinical improvement. CFV Doppler may serve as a practical adjunct for serial bedside assessment of right-sided hemodynamics after lung transplantation.