MOVIE LEGENDS
Movie 1. Modified mid-esophageal 4-chamber two-dimensional TEE view obtained prior to cannulation demonstrating severe left ventricular (LV) dilation, increased LV sphericity, and severe LV dysfunction. Spontaneous echo contrast consistent with low flow state is visualized within the LV. MV: mitral valve, RV: right ventricle; TEE: transesophageal echocardiography.
Movie 2. Modified aortic valve short-axis image with the TEE probe retracted slightly and rotated clockwise to center the desired transseptal puncture site in the two-dimensional image. A BRK transseptal puncture needle (St. Jude Medical, Minnesota, USA) is visualized at the center of the image tenting the interatrial septum (IAS). This image is essential to ensure appropriate orientation of the transseptal puncture needle in the anterior and posterior planes. Device leads are seen within the right atrium. TEE: transesophageal echocardiography
Movie 3. Nonstandard two-dimensional TEE window displaying a 6mm x 40mm peripheral balloon in long axis during atrial septostomy. After transseptal puncture and wire placement in the left atrium (LA), the location of the transseptal puncture site should be confirmed and the balloon position should be visualized in long axis to allow the imager and proceduralist to confirm location and vector prior to balloon septostomy. TEE: transesophageal echocardiography
Movie 4. Nonstandard two-dimensional TEE window demonstrating the advancement of a 23F Medtronic Bio-Medicus NextGen Multistage Venous Cannula (Medtronic, Minnesota, USA) under direct TEE visualization in long-axis. IAS: interatrial septum; TEE: transesophageal echocardiography
Movie 5. Nonstandard two-dimensional TEE window demonstrating positioning of a 23F Medtronic Bio-Medicus NextGen Multistage Venous Cannula (Medtronic, Minnesota, USA) under direct TEE visualization in long-axis after guidewire removal. IAS: interatrial septum; TEE: transesophageal echocardiography
Movie 6. Live three-dimensional (3D) TEE image used to guide and adjust position of the venous cannula and side ports within the left atrium. After satisfactory positioning of the distal and side ports in relation to intracardiac structures and the interatrial septum (IAS) this 3-D dataset was obtained and employed for intraprocedural multiplanar reconstruction to accurately measure the distance across the IAS. MV: mitral valve; TEE: transesophageal echocardiography.
Movie 7. Live 3D TEE dataset oriented to display a view of the heart from a basal to apical projection oriented anatomically to demonstrate final cannula position. 3-D: three-dimensional; AV: aortic valve; MV: mitral valve; TEE: transesophageal echocardiography; TV: tricuspid valve.