The Journal of invasive cardiology
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We report a case of a complicated vascular access secondary to systemic venous defects which have not been previously reported. Further evaluation revealed congenital absence of superior vena cava with two brachiocephalic veins draining separately. He also had absence of the hepatic segment of the inferior vena cava with azygos continuation. The patient did not have congenital anomalies of the remaining thoracoabdominal vasculature and viscera.
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Extracorporeal membrane oxygenation (ECMO) is an effective rescue method for severe respiratory and cardiac failure. Right ventricular (RV) failure with cardiogenic shock is a critical condition with generally poor prognosis unless aggressive therapeutical measures are undertaken. Authors report on their initial experience with ECMO support in severe RV failure with cardiogenic shock caused by an obstructive hemodynamic pattern. ⋯ Bleeding complications were the main complications observed. As per initial experience, veno-arterial ECMO allows bypassing of the pulmonary bed, therefore, relieves the RV pressure overload and does not cause further elevation of the pulmonary pressures in contrary to RV assist devices. This aggressive management approach requires further clinical evaluation in order to establish its definite role in critical RV failure.