Venovenous Extracorporeal Membrane Oxygenation for Cardiorespiratory Failure due to Congenital Diaphragmatic Hernia and Ebstein's Anomaly

Congenital diaphragmatic hernia (CDH) with concomitant congenital heart disease is associated with significant morbidity and mortality.1 The reported incidence of CDH is estimated to be one in 2000 to 5000 births,2 while estimated rates of concomitant congenital heart disease vary from 9 to 45 per cent.1, 2 Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is often used in neonates with CDH who have severe respiratory failure as it provides respiratory support with fewer neurologic complications than venoarterial (VA) ECMO.2 VA ECMO is commonly used when patients have congenital heart disease and need cardiac support.3 Ebstein's anomaly is a congenital cardiac defect characterized by apical displacement of the septal and posterior tricuspid valve leaflets leading to atrialization of the right ventricle.3 All previously reported cases of CDH and Ebstein's anomaly have used VA ECMO.3 We report a case of a patient with CDH and Ebstein's anomaly who was placed on VV ECMO due to cardiorespiratory failure and did well, never requiring conversion to VA ECMO. [...]VV ECMO may actually help improve intrinsic cardiac function through better diastolic filling of the coronaries with oxygenated blood, leading to increased ejection fraction and less myocardial stun.