This study test whether a lung recruitment maneuver improves the right ventricle performance after cardiopulmonary bypass. Half of the patients received an standard protective ventilation and the other half the same ventilatory pattern after a lung recruitment maneuver.

Atelectasis is developed in 90% of anesthetized patients after surgery.

Protective ventilation with low tidal volumes and positive-end expiratory pressure (PEEP) promotes atelectasis with the potential right ventricle dysfunction induced by the increment in afterload (activation of the pulmonary hypoxic vasocontriction reflex).

Lung recruitment can improve the right ventricle performance caused by atelectasis because the pulmonary hypoxic vasocontriction reflex desapear in a normal aerated lungs.

Inclusion Criteria:

• cardiovascular surgery with cardiopulmonary bypass.
• Patients with a New York Heart Association (NYHA) class I-II,
• Pre-operative left ventricular ejection fraction ≥ 50 %.
• Euroscore ≤ 6.

Exclusion Criteria:

• TEE contraindications.
• Hemodynamically unstable
• Needi for inotropic support