DK2985_C000 1..28 - AlSharqia Echo Club

324 Transesophageal Echocardiography(A) PA-PWD(B) (C) TTF-CWMax Vel: 60 cm/sMax Vel: 153 cm/sPG: 9.36 mmHg(D) PA-PWDMax Vel: 120 cm/s(E)RALALVRV(F) PA-PWDMax Vel: 80 cm/s(G)(H) TTF-CWMax Vel: 217 cm/sPG: 18.8 mmHgFigure 14.11 Evaluation of right ventricular performance during pericardiocenthesis in a 46-year-old woman with left ventricularassist device (LVAD) (Thoratec system). (A) The maximum systolic pulmonary artery pulsed-wave Doppler (PA-PWD) velocity was60 cm/sec just before the pericardial drainage began. (B, C) Mild tricuspid regurgitation is present with a tricuspid systolic pressure gradient(PG) of 9.36 mmHg. (D, E) With pericardiocenthesis, the maximum systolic pulmonary Doppler velocity increased to 120 cm/secbut then stabilized down to 80 cm/sec (F). This could have been secondary to unmasked right ventricular dysfunction associated withincreased tricuspid regurgitation (G, H). Of note, the cardiac output of the LVAD increased but the vasoactive support was unchanged(LA, left atrium; LV, left ventricle; Max, maximum; RA, right atrium; RV, right ventricle; TTF-CW, transtricuspid flow by continuouswaveDoppler; Vel, velocity).(A)(B)LARALVRVINFLOW CANNULA(C)(D)LVADAORTIC CANNULAFigure 14.12 (A, B) Mid-esophageal four-chamber view in a 37-year-old man with a Novacor system. (C) Continuous-wave Dopplervelocities from the inflow cannula. (D) Intraoperative view (LA, left atrium; LV, left ventricle; LVAD, left ventricular assist device;RA, right atrium; RV, right ventricle). (Photo D courtesy of Dr. Michel Carrier.)