Fig. 2

Cardiac catheterization performed for a 6-month-old baby that presented late with DORV, subpulmonic VSD, intramural left coronary artery, and hypoplastic aortic arch after arterial switch operation on ECMO support. The patient developed an iatrogenic AO to RV fistula that led to severe coronary steal, severe cardiac dysfunction, and inability to wean from ECMO support. a Contrast injection in the neo-aorta revealed a large AO-RV fistula (white asterisk) with a coronary steal (coronary arteries are not seen with neo-aortic injection). b Selective injection of the AO-RV fistula (white asterisk).c, d Neo-aortic injection after fistula is occluded with vascular plugs showed no residual fistula and no more coronary steal as coronary arteries are seen well after neo-aortic injection (yellow arrows). Three days later, the patient was successfully disconnected from ECMO, and contractility progressively improved and the patient was discharged home. DORV double outlet right ventricle, VSD ventricular septal defect, VC venous cannula, AC arterial cannula, AO aorta, RV right ventricle, ECMO extracorporeal membrane oxygenation