Dr. Wulkan, Surgeon-in-Chief, Children's Healthcare of Atlanta, presents a case of a 35 week gestational aged female with respiratory distress at birth and the ECHO shows super-systemic pulmonary pressure. The case study generated debate among panel members regarding approaches of VV ECMO versus VA ECMO as well as inhaled nitric oxide prior to ECMO. Other topics discussed include muscle flaps leading to scoliosis and chest conformities, respiratory acidosis during thoracoscopic repair, VV ECMO versus VA ECMO survival rates, timing of CDH repair on ECMO, and the types of patches is used in the repair.