Intraoperative Transesophageal Echocardiography-Guided Placement of Bicaval Dual-Lumen Extracorporeal Membrane Oxygenation Cannula.

• The Avalon catheter can establish VV ECMO via the right internal jugular vein. • Proximal and distal inflow orifices should be positioned in the SVC and IVC. • The cannula is aimed toward the tricuspid valve to deliver blood through the valve. • TEE is used to guide cannula placement and evaluate final position and cannula flow. • Malposition of cannulas may cause complications (e.g., tissue injury, low ECMO flow).