A 33-year-old man with Rendu–Osler and congenital aortic stenosis corrected with Ross surgery. Severe stenosis of the homograft with transcatheter implantation of a Melody pulmonary valve device (Medtronic, Minneapolis, MN, United States). Severe mixed postcapillary pulmonary hypertension with severe right ventricular dysfunction led to his inclusion on the heart–lung transplant list. He was admitted for respiratory failure, which required percutaneous veno-venous ECMO. Fig. 1 illustrates the femoral drainage cannula in the inferior vena cava (A), the jugular return cannula in the right atrium (B), and the Melody valve in the pulmonary artery (C) are visible. Hemodiafiltration was required due to right heart failure. On day 5, we decided to switch to a ProtekDuo double-lumen cannula (LivaNova, London, United Kingdom) for right heart support with an oxygenator as a bridge therapy to heart-lung transplant. Fig. 2 illustrates the ProtekDuo cannula (D) traversing the Melody valve (C), with drainage into the right atrium and the distal return end in the pulmonary artery. Hemodiafiltration was discontinued 1 week later. The patient underwent rehabilitation while waiting for the transplant. However, he presented with uncontrollable GI bleeding and ended up dying 2 weeks later.

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