Figure 2.

Preoperative Echocardiography

(A) Severe tricuspid regurgitation (TR) on transthoracic echocardiography (TTE) associated with dilated right atrium (RA) and normal right ventricular (RV) size. Transesophageal echocardiography (TEE) demonstrated a curved RA wire prolapsing across the tricuspid valve (TV), suggesting adherence of the RV pacing wire to the tricuspid valve (B), causing severe TR on either side of the RV pacing wire (C), reversed systolic flow in the hepatic vein (D), and normal flow velocities across the mitral valve (MV). Decel = deceleration; PG = pressure gradient; Vel = velocity.