Fig. 2

Transesophageal echocardiographic hemodynamic monitoring in a patient with a known ischemic cardiomyopathy who failed ventilator weaning. Under pressure support, a trivial mitral regurgitation was disclosed by color Doppler mapping in the two-chamber view (upper left), and left cardiac filling pressures were low, as reflected by an inverted mitral E/A Doppler pattern (middle left) and a predominant pulmonary vein S wave (lower left). During the spontaneous breathing trial, a severe mitral regurgitation occurred (upper right), mitral Doppler pattern was restrictive (middle right), and pulmonary vein Doppler disclosed a reversed D wave consistent with massive mitral insufficiency (lower right, arrow). The acute mitral regurgitation was attributed to a papillary muscle dysfunction secondary to a transient myocardial ischemic event. LA left atrium, La left auricle, LV left ventricle. Adapted from [7]