Navigating Extreme Ventilation-perfusion Mismatches: Hybrid ECMO for ARDS with Right Ventricular Dysfunction in a Patient with Unilateral Agenesis of the Right Pulmonary Artery: A Case Report

BackgroundUnilateral agenesis of the pulmonary artery (UAPA) is a rare congenital anomaly that poses significant challenges in the management of acute respiratory failure due to complex ventilation-perfusion mismatch.The use of extracorporeal membrane oxygenation (ECMO) in such patients has rarely been described. Case ReportWe report a young female with right pulmonary artery agenesis, severe acute respiratory distress syndrome (ARDS), refractory hypoxemia, hypercapnia, shock, and right ventricular (RV) dysfunction, successfully managed with primary hybrid veno-arterialvenous (V-AV) ECMO. ConclusionThis case highlights the role of tailored ECMO configurations in managing complex cardiopulmonary interactions and represents one of the first reported cases of UAPA with ARDS supported using ECMO.