INTRODUCTION
A 53 year-old male with chronic combined heart failure (HF) due to
dilated ischemic cardiomyopathy presented in cardiogenic shock to the
hybrid catheterization lab for institution of veno-arterial
extracorporeal membrane oxygenation (VA-ECMO) as a bridge to cardiac
transplantation. To provide adequate drainage and decompression of both
right and left atria the decision was made to place a single venous
cannula across the interatrial septum (IAS) with the goal of positioning
the distal orifice and side ports within the left atrium (LA) and the
proximal set of side ports within the right atrium (RA) or inferior vena
cava (IVC) for left atrial veno-arterial
(LAVA)-ECMO1,2. Three-dimensional (3D) transesophageal
echocardiography (TEE) was employed to guide cannula placement and
positioning.