Answer 2

This is a mid-esophageal 2-chamber view of the LV. (2-chamber because you can see the left atrial appendage on the R side of the image.) The anterior wall of the LV is akinetic in the mid- and apical segments, with only the basal segment contracting. The anterior wall is not thinned and scarred as would be consistent with an old infarct, but seems to be of normal thickness, so this most likely represents acute ischemia in the LAD territory.

Initial treatment should involve measures to resolve the ischemia, such as nitroglycerin infusion, with vasopressor to maintain MAP. Maximizing oxygen delivery by ensuring adequate HCT (in this setting >30 would be appropriate) and PaO2 would also be relevant. The response can be monitored with TEE, and by resolution of EKG changes (if present). Further management would obviously depend on how far through the operation the surgeons are, and how unstable the patient is.