1. A novel strategy to improve systemic oxygenation in venovenous extracorporeal membrane oxygenation: The “χ-configuration” 
Massimo Bonacchi, MD, Guy Harmelin, MD, Adriano Peris, MD, Guido Sani, MD 
The Journal of Thoracic and Cardiovascular Surgery 
Volume 142, Issue 5, Pages (November 2011)
DOI: /j.jtcvs
Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

2. Figure 1
The “customized” arterial cannula. A, The nonmodified cannula: with the mandrel in place (left) and with the mandrel removed (right). B, The self-made modified arterial cannula: with the mandrel in place (left) and with the mandrel removed (right). C, The customized cannula tip (particular): with the mandrel in place (left) and with the mandrel removed (right). The arrows indicate the polypropylene single stitches making a 60° curvature with a soft left rotation.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

3. Figure 2
The χ-configuration modified VV-ECMO cannulation. Blood is drained from the two venae cavae (superior [SVC] and inferior [IVC]) by a multihole cannula placed, through the right femoral vein, to the right atrium with the tip just below on the SVC. Arterialized blood is returned to the right atrium through the self-made modified arterial cannula (23 cm long) placed through the right internal jugular vein with the tip toward the tricuspid valve (TV). A polypropylene stitch was used to make 4 consecutive bites over the distal 3-4 cm of the arterial cannula to create the desired curvature and a soft left rotation.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

4. Figure 3
Plain chest x-ray film shows the lazy curvature of the in flow cannula from the right neck base toward the right ventricle. The cannula tip (*) and the tricuspid valve plan (continuous line) are marked. The drawing cannula is located in right atrium below the superior vena cava.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs )
Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions