Temporary fenestration using venoatrial extracorporeal membrane oxygenation after the Fontan operation

A 28.7-month-old male child who had undergone a Norwood operation and bidirectional cavopulmonary shunt at the age of 5 days and 6.6 months, respectively, underwent the extracardiac conduit Fontan operation. After the operation, high-volume resuscitation was needed, which led to high central venous pressure (CVP) and low arterial oxygen saturation. Venoatrial extracorporeal membrane oxygenation (ECMO) was initiated between the superior vena cava and the right atrium with one third of the expected normal cardiac output. This low-flow venoatrial ECMO immediately terminated the vicious cycle caused by high venous pressure in the Fontan circulation. He was weaned from ECMO and discharged home.