{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T07:06:30Z","timestamp":1779433590563,"version":"3.53.1"},"reference-count":12,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiological Reports"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Systemic\u2010to\u2010pulmonary venous shunting is a rare cause of refractory hypoxemia. Its prompt recognition is crucial, as management requires not only etiological treatment but also the restoration of physiological venous return. We report the case of a 40\u2010year\u2010old man presenting with dyspnea, cervicothoracic edema, and hypoxemia. Imaging revealed a mediastinal mass compressing the superior vena cava (SVC), with associated subocclusive thrombosis in its lower segment and right pulmonary artery. Endobronchial ultrasound\u2010guided puncture and video\u2010assisted thoracoscopic marsupialization confirmed a benign bronchogenic cyst. Following anesthesia induction, the patient developed refractory hypoxemia requiring Veno\u2010Arterial Extracorporeal Membrane Oxygenation, chosen due to prohibitive obstruction of the SVC preventing veno\u2010venous access. Persistent hypoxemia prompted further investigations, revealing a right\u2010to\u2010left shunt through a mediastinal venous cavernoma connecting upper\u2010body venous return to the pulmonary veins. Mechanical thrombectomy of the SVC using the ClotTriever system restored venous patency, allowing ECMO weaning and full clinical recovery. This case highlights an exceptional systemic\u2010to\u2010pulmonary venous shunt. Successful management required a multimodal strategy integrating bronchoscopic, surgical, and endovascular interventions with ECMO support. Clinicians should consider extracardiac venous shunting as a rare cause of refractory hypoxemia and select the optimal ECMO configuration after careful evaluation of both hemodynamic status and vascular anatomy.<\/jats:p>","DOI":"10.14814\/phy2.70847","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T05:01:21Z","timestamp":1774846881000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The helpful support of veno\u2010arterial extracorporeal membrane oxygenation to treat an exceptional systemic\u2010to\u2010pulmonary venous shunt: A case report"],"prefix":"10.14814","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7213-4214","authenticated-orcid":false,"given":"Ludovic","family":"van Delden","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine Geneva University Hospitals  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matis","family":"Grundheber","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine Geneva University Hospitals  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Looyens","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine Geneva University Hospitals  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9070-5834","authenticated-orcid":false,"given":"Benjamin","family":"Assouline","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine Geneva University Hospitals  Geneva 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Medicine Geneva University Hospitals  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/468237"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.5.3639"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.21037\/med\u201022\u201046"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13133795"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886\u2010020\u201001335\u20109"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.301095724"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt\u20102019\u2010001150"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002\u20109149(87)90939\u20108"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/aor.14961"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.md.0000198474.99876.f0"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.148.2.259"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd010381"}],"container-title":["Physiological 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