title: A case report of central extracorporeal membrane oxygenation after implantation of a left ventricular assist system: femoral vein and left atrium cannulation for ECMO.
abstract: OBJECTIVE
  The left ventricular assist system (LVAS) is often used for end-stage heart failure. However, in severe lung disorder, the patient needs extracorporeal membrane oxygenation (ECMO) because oxygenation using only a ventricular assist system (VAS) is insufficient. We report a successful case of combining the use of LVAS and right VAS (RVAS) with ECMO.
  
  
  METHODS
  A 40-year-old female developed cardiogenic shock secondary to end-stage dilated cardiomyopathy, and percutaneous cardiopulmonary support (PCPS) was initiated. An echocardiogram showed a low ejection fraction (11%), and she underwent implantation of an LVAS (Toyobo Ventricular Assist System). She also required a RVAS with ECMO shunting between the right and left atrium because there was insufficient oxygenation resulting from pulmonary dysfunction followed by severe lung edema.
  
  
  RESULTS
  Pulmonary function recovered successfully, and the RVAS-ECMO was removed after 7 days of support. There were no complications after operation, such as infection, bleeding, or systemic embolization.
  
  
  CONCLUSIONS
  LVAS combined with RVAS-ECMO in right and left atrial cannulation is a useful option for patients with severe pulmonary damage.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The Cardiovascular Institute Hospital, Tokyo, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Yoda
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Hata
authors.forename: Akira
authors.initials: A
authors.lastname: Sezai
authors.forename: Kazutomo
authors.initials: K
authors.lastname: Minami
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D002406:Catheterization, Peripheral; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005268:Femoral Vein; D006325:Heart Atria; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D011654:Pulmonary Edema / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*