FIGURE LEGENDS
Figure 1. Modified mid-esophageal 4-chamber two-dimensional TEE view obtained prior to cannulation demonstrating severe left ventricular dilation and increased sphericity. LV: left ventricle, MV: mitral valve, RV: right ventricle; TEE: transesophageal echocardiography
Figure 2. Live three-dimensional (3D) TEE image obtained during positioning of the venous cannula across the interatrial septum (IAS) used for guidance and as the source image to perform multiplanar reconstruction to measure the distance the cannula tip extended across the IAS. AV: aortic valve; TEE: transesophageal echocardiography; TV: tricuspid valve.
Figure 3. Live 3D TEE image of the final cannula tip position within the left atrium (LA). The green line displays the measured distance of the cannula across the IAS (43mm) projected onto three-dimensional space. This measurement was obtained using multiplanar reconstruction for optimal plane alignment just as performed on the ultrasound system in the catheterization lab at the time of cannulation (see Figure 5). .Other abbreviations as in previous figures.
Figure 4. Live 3D TEE image projected to demonstrate a basal view of the heart aligned in anatomical position to demonstrate the course of the venous cannula across the IAS. Abbreviations as in previous figures.
Figure 5. Multiplanar reconstruction of a 3-D dataset (Figure 2 demonstrates original 3-D capture) demonstrating plane alignment on the venous cannula used to accurately measure the distance the cannula tip projected into the LA. Abbreviations as in previous figures.
Figure 6. Nonstandard TEE window demonstrating final position of a 23F Multistage Venous Cannula with color Doppler flow noted at the distal tip and side ports after initiation of left atrial veno-arterial (LAVA)-ECMO. Abbreviations as in previous figures.