Figure 3.

Intraoperative TEE

(A) ME 4-chamber view with an anechoic cavity at the apical region (yellow arrow). A systolic color Doppler signal (blue arrow) is directed in the RV. (B) Continuous-wave Doppler interrogation of the RV fistula signal with a diastolo-systolic peak gradient of 3.2 m/s (41 mm Hg). (C) ME 4-chamber view showing the mycotic aneurysm (yellow arrow) and a lower velocity diastolic signal (red arrow) are seen in the LV. (D) Biplane RV outflow tract and ME aortic long-axis view in which the mycotic aneurysm is seen (yellow arrow). Both the RV fistula (blue arrow) and the LV fistula (red arrow) are present (see Video 3). ME = midesophageal; TEE = transesophageal echocardiography; other abbreviations as in Figure 1.