Hemodynamics case 2

A 71 year old man with a history of type 2 diabetes, HTN and COPD is having a laparotomy for a small bowel obstruction. During the case he becomes tachycardic and his blood pressure falls to 80/40. Initially there is some response to vasopressors, but then his hypotension becomes more refractory and is requiring 20mcg boluses of epinephrine to maintain a systolic pressure over 70mmHg. The HCT is 23 on the gas that you sent. You introduce a TEE probe and attain the following view.

What is your diagnosis?

What would your treatment involve?