Hypoxemia Requiring Venovenous Extracorporeal Membrane Oxygenation after Tricuspid Valvulectomy for Infective Endocarditis.

• TEE is essential in the diagnosis and management of IE related to IVDU. • Tricuspid valvulectomy is performed to manage IVDU-associated IE involving the TV. • Intracardiac shunt is possible if refractory hypoxemia occurs after cardiac surgery. • Flow through a PFO depends on loading conditions of the right atrium. • VV ECMO can be used to manage hypoxemia related to intracardiac shunt.