Fig. 1

(A) Dissection of the IVC ligament. TT extends above major hepatic veins, but below the diaphragm (level IIIc). (B) After the IVC ligament is divided TT “uncoils” and now extends into the right atrium (level IV). (C) Under TEE guidance, the TT is pulled down to the infrahepatic IVC through the cavotomy, allowing repositioning of the vascular clamp below the major hepatic veins and releasing of the Pringle maneuver. (D) Cavotomy is closed and all vascular clamps are released