We report a successful case of extracorporeal membrane oxygenation (ECMO) 
support for a 7-year-old girl with acute fulminant myocarditis, and describe the 
pitfalls and management of ECMO. The problem with ECMO is that it may not reduce 
the afterload of the left ventricle (LV), and may be associated with increased 
LV wall stress and deteriorating pulmonary congestion. It is important for ECMO 
management to find the best balance between flow support and LV afterload.