{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T06:17:33Z","timestamp":1788675453852,"version":"build-2803163510"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transoesophageal echocardiography (TEE) is generally considered a low-risk procedure. However, in patients with severe tricuspid regurgitation (TR) complicated by right ventricular (RV) dysfunction and pulmonary hypertension (PH), standard procedural sedation can precipitate life-threatening haemodynamic collapse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>An 83-year-old woman with end-stage renal disease, severe PH (95\u2005mmHg), and severe TR underwent a TEE. Shortly after induction with propofol and probe insertion, the patient developed profound systemic hypotension (56\/30\u2005mmHg). Real-time TEE imaging revealed acute, severe RV dilatation and a precipitous decline in systolic function. The procedure was immediately aborted, and the patient was stabilized with intravenous phenylephrine and ephedrine. She returned to her haemodynamic baseline within 20\u2005min of procedure termination and probe removal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights the \u2018triple hit\u2019 effect that places patients with RV failure at high risk during sedation: propofol-induced systemic vasodilation, the vagal response to probe insertion, and hypercapnia-induced increases in pulmonary vascular resistance (PVR). For this high-risk phenotype, a \u2018slow and low\u2019 anaesthetic titration, meticulous PVR management, and early consideration of RV-protective vasopressors are essential to prevent catastrophic RV-pulmonary uncoupling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag423","type":"journal-article","created":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T11:39:30Z","timestamp":1780745970000},"source":"Crossref","is-referenced-by-count":1,"title":["A case report of acute right ventricular failure in a patient undergoing transoesophageal echocardiogram for evaluation of tricuspid regurgitation"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3207-5843","authenticated-orcid":false,"given":"Mustafa","family":"Mohammed","sequence":"first","affiliation":[{"name":"Division of Cardiology, Henry Ford Health System , 2799 West Grand Blvd, Detroit, MI 48202 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Chou","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Henry Ford Health System , 2799 West Grand Blvd, Detroit, MI 48202 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachin","family":"Parikh","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Henry Ford Health System , 2799 West Grand Blvd, Detroit, MI 48202 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5981-8071","authenticated-orcid":false,"given":"Alexandra","family":"DePorre","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Henry Ford Health System , 2799 West Grand Blvd, Detroit, MI 48202 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"McCord","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Henry Ford Health System , 2799 West Grand Blvd, Detroit, MI 48202 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"2026062213520592300_ytag423-B1","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1053\/j.jvca.2025.02.041","article-title":"Safety of transesophageal echocardiography in patients referred for tricuspid valve disease at a center for structural heart disease","volume":"39","author":"Chou","year":"2025","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2026062213520592300_ytag423-B2","doi-asserted-by":"crossref","DOI":"10.2174\/1573403X19666230206115611","article-title":"Acute right ventricular failure: pathophysiology, diagnostic approach with emphasis on the role of echocardiography","volume":"19","author":"Tun","year":"2023","journal-title":"Curr Cardiol Rev"},{"key":"2026062213520592300_ytag423-B3","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/j.echo.2013.07.009","article-title":"Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists","volume":"26","author":"Hahn","year":"2013","journal-title":"J Am Soc Echocardiogr"},{"key":"2026062213520592300_ytag423-B4","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.chest.2016.09.001","article-title":"Hypoxic pulmonary vasoconstriction: from molecular mechanisms to medicine","volume":"151","author":"Dunham-Snary","year":"2017","journal-title":"Chest"},{"key":"2026062213520592300_ytag423-B5","first-page":"7427127","article-title":"Cardiac arrest during transesophageal echocardiogram (TEE) due to acute right ventricular failure","volume":"2021","author":"Kersey","year":"2021","journal-title":"Case Rep Cardiol"},{"key":"2026062213520592300_ytag423-B6","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1056\/NEJMoa2401918","article-title":"Transcatheter valve replacement in severe tricuspid regurgitation","volume":"392","author":"Hahn","year":"2025","journal-title":"N Engl J Med"}],"container-title":["European Heart Journal - 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