Fig. 1.

Transthoracic echocardiogram (TTE) of case 1 (24 h after invasive mechanical ventilation). (A) Apical 4-chamber view without right ventricular (RV) dilatation. (B) TAPSE (measured by aligning an M-mode cursor parallel with the RV free wall as it meets the tricuspid annulus from the RV apical four-chamber view) with a normal value (17.8 mm). (C) S wave (measured with tissue Doppler placing the sample volume at the tricuspid annular level) with a normal value (13.6 cm/s). TTE ofcase 1after hemodynamic deterioration. (D) Dilated RV with a RV/LV ratio >1. (E) Diminished TAPSE (12 mm). (F) Diminished S wave (9.4 cm/s); both compatible with longitudinal RV systolic dysfunction.

TAPSE, tricuspid annular plane systolic excursion; S wave, tricuspid peak systolic S wave tissue Doppler velocity; LV, left ventricle; RA, right atrium; LA, left atrium.