Left Ventricular Venting Using a Transaortic Pigtail Catheter in Pediatric Myocarditis Requiring Extracorporeal Membrane Oxygenation

Patients with fulminant myocarditis accompanied by severe hemodynamic deterioration, cardiogenic shock, or refractory arrhythmias often require venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment. When left ventricular (LV) dilation, elevated LV end-diastolic pressure, or severe pulmonary congestion occurs during VA-ECMO, LV venting may be necessary to protect the left ventricle. In this case series, we describe a percutaneous LV venting technique in three pediatric patients with fulminant myocarditis treated with VA-ECMO. Specifically, a pigtail catheter was retrogradely inserted into the LV and used as a venting device. Effective LV unloading was achieved in all patients, allowing successful weaning from ECMO. One patient developed limb ischemia requiring distal perfusion, but no additional catheter-related complications occurred. This approach offers a less invasive option for LV unloading in pediatric VA-ECMO, providing technical simplicity and reducing both the surgical burden and bleeding risk. To the best of our knowledge, this is the first case series to detail the use of a pigtail catheter for LV unloading in pediatric VA-ECMO.