Transesophageal echocardiography (TEE) is becoming a more prevalent method of monitoring and diagnosis in the perioperative setting for critically ill patients and patients undergoing cardiac surgery. Many TEE measurements are extrapolated from transthoracic echocardiography (TTE) data and have not validated by transesophageal means. The aim of this study is to validate TEE assessment of right ventricular function by comparing them to simultaneously measured TTE measurements.

Likewise, there are currently no agreed upon values for RV free wall strain. Therefore, the investigators will attempt to define a range of normal values of RV free wall strain as compared to the other measures of RV function.

Traditionally, all echocardiographic measurements have been studied utilizing TTE. Therefore the normal values and ranges for pathology findings have been defined by transthoracic means alone. TEE offers different images planes when compared to TTE, which may make the measurements obtained differ from those obtained by TTE. In the operating room environment the vast majority of echocardiography is completed by transesophageal means for many reasons; largely access to the patient and the continuous use of TEE as a hemodynamic monitor. However, given the fact that most echocardiographic measurements have only been validated by TTE, there remains a question as to the validity or precision of TEE-derived measurements.

Inclusion Criteria:

• Adult patients undergoing elective cardiac surgery requiring TEE

Exclusion Criteria:

• Patient who do not wish to consent
• Patients with contraindications to TEE
• Urgent or emergent cardiac surgery
• Patients with preexisting open chest
• Patients with intrathoracic hardware (VAD, thoracostomy tube, etc)
• Non-English speaking subjects
• Cognitively impaired adults
• Pregnancy

All patients undergoing elective cardiac surgery, which as a standard of care, requires transesophageal echocardiography.