Helen is a 53yo female admitted to the referring hospital with acute and progressive SOB. She is transferred to your center’s pulmonary critical care team and immediately intubated, where she had a brief arrest, but was quickly resuscitated. They believe she has severe ARDS of uncertain etiology, and that she is a good candidate for VV ECMO. You are the CT surgeon on call for ECMO cannulation and come to see her while the ECMO circuit and team are being mobilized. A quick discussion with her family who has just arrived reveals a history of asthma with COPD, GERD and they think she had some sort of heart valve ballooned about two years ago, and had a pacemaker placed last year. They are unsure if she ever had a heart attack. You immediately call for a stat echo, which confirms that the patient has severe Mitral Stenosis.