TEE (midesophageal 4-chamber view) of right ventricular failure

This video of the mid-esophageal four-chamber view demonstrates the following classic findings of right ventricular failure: basal hypokinesis, reduced or absent tricuspid annular excursion, chamber enlargement, and paradoxical septal motion. There is apical sparing of right ventricular free wall dysfunction (known as McConnell's sign); this sign is associated with acute massive pulmonary embolism, but has also been identified in patients with other causes of right ventricular dysfunction including right ventricular ischemia and other causes of pulmonary hypertension.