The helpful support of veno‐arterial extracorporeal membrane oxygenation to treat an exceptional systemic‐to‐pulmonary venous shunt : A case report

Article Article scientifique Rapport de cas The helpful support of veno‐arterial extracorporeal membrane oxygenation to treat an exceptional systemic‐to‐pulmonary venous shunt : A case report eng 2026-03-29 2026-04 author Van Delden-Schulz-Nadler Ludovic 0009-0001-7213-4214 Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine Geneva University Hospitals Geneva Switzerland 805291 author Grundheber Matis Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine Geneva University Hospitals Geneva Switzerland 772331 author Looyens Carole Marie Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine Geneva University Hospitals Geneva Switzerland 417580 author Assouline Benjamin 0000-0002-9070-5834 Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine Geneva University Hospitals Geneva Switzerland 595385 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Papillard Matthieu 0009-0004-6968-695X Department of Radiology and Medical Informatics Geneva University Hospitals Geneva Switzerland 410228 author Giraud Raphaël 0000-0001-5956-8643 Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine Geneva University Hospitals Geneva Switzerland 639599 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Bendjelid Karim 0000-0002-7921-7207 Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine Geneva University Hospitals Geneva Switzerland 527948 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) e70847 10.14814/phy2.70847 41906336 2051-817X Systemic‐to‐pulmonary venous shunting is a rare cause of refractory hypoxemia. Its prompt recognition is crucial, as management requires not only etiological treatment but also the restoration of physiological venous return. We report the case of a 40‐year‐old man presenting with dyspnea, cervicothoracic edema, and hypoxemia. Imaging revealed a mediastinal mass compressing the superior vena cava (SVC), with associated subocclusive thrombosis in its lower segment and right pulmonary artery. Endobronchial ultrasound‐guided puncture and video‐assisted thoracoscopic marsupialization confirmed a benign bronchogenic cyst. Following anesthesia induction, the patient developed refractory hypoxemia requiring Veno‐Arterial Extracorporeal Membrane Oxygenation, chosen due to prohibitive obstruction of the SVC preventing veno‐venous access. Persistent hypoxemia prompted further investigations, revealing a right‐to‐left shunt through a mediastinal venous cavernoma connecting upper‐body venous return to the pulmonary veins. Mechanical thrombectomy of the SVC using the ClotTriever system restored venous patency, allowing ECMO weaning and full clinical recovery. This case highlights an exceptional systemic‐to‐pulmonary venous shunt. Successful management required a multimodal strategy integrating bronchoscopic, surgical, and endovascular interventions with ECMO support. Clinicians should consider extracardiac venous shunting as a rare cause of refractory hypoxemia and select the optimal ECMO configuration after careful evaluation of both hemodynamic status and vascular anatomy. ECMO Bronchogenic cyst Endovascular therapy Mediastinal venous cavernoma Superior vena cava syndrome Systemic‐to‐pulmonary venous shunt Dewey 616.0757 Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 62 Département de radiologie et informatique médicale 227 false 570 Groupe de recherche en hémodynamique 913 Physiological reports 14 7 d7f0ed23-8841-4f19-954f-372e30caf75a Article (Published version) Public Physiological_Reports_-_2026_-_Deld.pdf 686042 application/pdf CC BY-4.0 945c29e69db17f46e5271cc71807515ede410b6631653a7d0b99fcb3dea626a2 28f4f76c-6591-4786-b88f-73df2f312089 Supplemental data Public phy270847-sup-0001-appendixs1.pdf 105535 application/pdf 2a6a58eadf67efcaea19459c4b3db877e584f5ba8d4d013197d43f89c6aff27d openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale

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The helpful support of veno‐arterial extracorporeal membrane oxygenation to treat an exceptional systemic‐to‐pulmonary venous shunt : A case report	Physiological reports			2026	19	67

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Grundheber, Matis