The issue of left ventricular (LV) distention during venoarterial extracorporeal membrane oxygenation (VA-ECMO) is crucial as it markedly impacts on patients’ weanability and, ultimately, outcome. Numerous techniques have been described to prevent and reduce its occurrence, each with advantages and limitations,^2–4 and percutaneous left-heart decompression via the pulmonary artery has a very intriguing pathophysiological rationale, allowing for retrograde unloading of the LV. This technique presents with some advantages. First, it is performed at the bedside with a completely percutaneous approach. Second, the amount of blood drained is related to the flow in the pulmonary artery; hence, an increase in right ventricular ejection will result in an augmented drainage. Last, the pulmonary artery cannula can be used as a return cannula for temporary percutaneous right ventricular support.⁵