Diagnostic Dilemmas| Volume 17, ISSUE 2, P269-270, April 2003

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An abnormal TEE on bypass

      A 56-year-old man underwent elective coronary artery bypass grafting for 3-vessel coronary disease. After aortic and venous (with a single, double-staged venous cannula) cannulation, cardiopulmonary bypass was initiated. However, after the start of cardiopulmonary bypass, poor venous return and cardiac distention were noticed. Transesophageal echocardiography (TEE) revealed the following images (Figs1-3).
      Figure thumbnail gr1
      Fig. 1An 18° view of the right atrium, liver, diaphragm, inferior vena cava and a hepatic vein.
      Figure thumbnail gr2
      Fig. 2TEE after rotation of the probe to 29°.
      Figure thumbnail gr3
      Fig. 3TEE after rotation of the probe to 98°.
      What is the diagnosis?


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