title: Intracardiac Right-to-Left Shunt Impeding Liberation From Veno-Venous Extracorporeal Membrane Oxygenation: Two Case Studies.
abstract: OBJECTIVE
  Veno-venous extracorporeal membrane oxygenation is an increasingly used form of advanced respiratory support, but its effects on the physiology of the right heart are incompletely understood. We seek to illustrate the impact of veno-venous extracorporeal membrane oxygenation return blood flow upon the right atrium by considering the physiologic effects during interatrial shunting.
  
  
  METHODS
  Two veno-venous extracorporeal membrane oxygenation patients in whom an extracorporeal membrane oxygenation induced right-to-left interatrial shunt appears to have created a barrier to liberation from extracorporeal support.
  
  
  CONCLUSIONS
  Veno-venous extracorporeal membrane oxygenation return flow generates a high-pressure jet that has potential to exert focal pressure upon the intra-atrial septum. In patients with potential for interatrial flow, this may lead to a right-to-left shunt, which becomes physiologically apparent only when sweep gas flow is ceased.
authors.affiliation: 1Department of Intensive Care, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. 2Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Gillon
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Barrett
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ioannou
authors.forename: Luigi
authors.initials: L
authors.lastname: Camporota
authors.forename: Kelly
authors.initials: K
authors.lastname: Victor
authors.forename: Abigail
authors.initials: A
authors.lastname: Gowland
authors.forename: Christopher I S
authors.initials: CI
authors.lastname: Meadows
authors.forename: Christopher
authors.initials: C
authors.lastname: Langrish
authors.forename: Stephen
authors.initials: S
authors.lastname: Tricklebank
authors.forename: Duncan
authors.initials: D
authors.lastname: Wyncoll
mesh_terms: D000328:Adult; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006343:Heart Septal Defects / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D017725:Ventricular Pressure