Congenital vascular abnormality often presents with complicated anatomy and physiology that may result in very challenging anesthesia management, particularly for a small child.1,2  Understanding the uniqueness of the anatomy and physiology is critical to optimize the care of the patient with unique vascular abnormality. Panels A and B show computed tomography and a three-dimensional reconstructed image of pulmonary sequestration and feeding vessels of 1-yr-old boy. However, it was still challenging to identify the take-off of the feeding vessels under direct vision in the surgical field, and the surgeon inadvertently and incorrectly ligated the feeding vessels. Due to the complexity of the case, the anesthesia care team placed an arterial line in the right radial artery to monitor upper extremity perfusion and placed a pulse oximeter on the left foot to monitor lower extremity perfusion...

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