67: Successful Use of VV ECMO for Treating Non-Cardiogenic Pulmonary Edema After the Ross Procedure

Background: This clinical case report details the management of a 12-year-old child with severe congenital heart defects, including combined aortic valve defect, left ventricular outflow tract (LVOT) obstruction, moderate mitral and severe tricuspid insufficiency, and anomalous superior vena cava—who developed post-perfusion lung injury following prolonged cardiopulmonary bypass (CPB). Severe post-perfusion lung injury is associated with high mortality and may require extracorporeal support. Methods: Patient A., a 12-year-old child, underwent the Ross procedure with mitral and tricuspid valve repair, resection of the pre-valvular aortic membrane, and ventricular septal myectomy. Aortic occlusion time was 207 minutes, with total CPB of 257 minutes. After weaning from CPB, the patient developed severe hypoxemic respiratory failure (SaO2 65–70%, oxygenation index 56 on 100% FiO2) with significant pulmonary edema. TRALI was excluded. In the setting of profound respiratory failure with preserved biventricular function on transesophageal echocardiography, peripheral veno-venous (VV) ECMO was initiated. ECMO support was continued for 16 days until respiratory recovery. Results: Post-perfusion acute lung injury presents diagnostic and therapeutic challenges, often necessitating differentiation from cardiac failure. Initial VA ECMO is frequently chosen but may require conversion. In cases of isolated, severe lung injury with preserved cardiac function, VV ECMO represents the optimal support strategy. The patient successfully recovered respiratory function with VV ECMO without complications.