Depiction of the heart showing incompetent tricuspid valve with tricuspid regurgitation

Depiction of the heart showing left and right atria, left and right ventricles, left ventricular assist device inflow and outflow cannulas, and incompetent tricuspid valve with tricuspid regurgitation. Arrow 1, decompression of left ventricle (potential "suction event" if decompression impairs cannula inflow); arrow 2, shift of interventricular septum (affecting septal contribution to right ventricular contractility); arrow 3, structural "weakening" of the right atrium/right ventricle secondary to pericardial "violation" after surgical manipulation; arrow 4, increased left ventricular assist device output increasing right ventricular filling and preload; arrow 5, significant right atrium and right ventricular dilation with tricuspid annular dilation and regurgitation adding to postbypass ischemia/reperfusion injury of right ventricle and eventually impairment of right ventricular contractility; arrow 6, potential right ventricular failure impairing left ventricular assist device filling and output, worsening ischemia.