Successful Implementation of Peripheral Venoarterial ECMO in a Patient With Eisenmenger Syndrome as a Bridge to Lung Transplant: A Case Report

Eisenmenger syndrome (ES) is a form of cyanotic congenital heart disease resulting in pulmonary hypertension and right-to-left shunting. End-stage ES often requires lung transplantation and patients may require extracorporeal membrane oxygenation (ECMO) as a bridge, though the optimal cannulation strategy is not standardized. A 49-year-old woman with ES due to unrepaired ostium secundum atrial septal defect presented with acute on chronic pulmonary embolism and refractory hypoxemia, ultimately requiring VA ECMO cannulation, which was complicated by venous cannula migration across the ASD and into the left atrium, requiring bedside repositioning under echocardiographic guidance. Differential hypoxemia was managed throughout her ECMO course and she was ultimately bridged to bilateral lung transplantation after three days. ECMO use in ES is complex and requires appreciation of the inherent limitations of each cannulation strategy. Peripheral VA ECMO can serve as a short-term strategy when emergent circulatory support is needed.