Planned initiation of V-A ECMO prior to liver transplantation in a patient with severe portopulmonary hypertension.

We describe a novel approach to managing a patient with severe, medically refractory portopulmonary hypertension (PPH) undergoing high risk LT. In this case, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) was initiated in planned fashion following induction of anesthesia to provide intraoperative cardiac support and facilitate LT.