Right ventricular dissection diagnosed on transesophageal echocardiography.

53-yr-old woman with a left ventricular assistdevice (LVAD), placed 4 mo before admission foridiopathic dilated cardiomyopathy, was awaitingheart transplantation. She was found unresponsive athome with low cardiac output from her LVAD. Nosigns of fractures or thoracic bruising were presentand she did not require chest compressions for resus-citation. During transport to the hospital, she wastracheally intubated, started on inotropic drugs, andtransferred directly to the operating room on arrival tothe hospital for surgical evaluation.Transesophageal echocardiography (TEE) was per-formed in the operating room to evaluate the patient’scritical condition. TEE demonstrated a fluid collectionadjacent to the right ventricle (RV) in the midesopha-geal four-chamber view at 0° and midesophageal longaxis view at 87° rotation (Fig. 1, video clip 1; please seevideo clip available at www.anesthesia-analgesia.org).The LVAD inflow cannula in the left ventricle did notshow any signs of obstruction or malpositioning, theLVAD outflow cannula in the aorta was not visible onTEE, although TEE is an ideal technique for evaluatingLVAD placement and function.