Intraprocedural imaging of the inflow and outflow cannulas of the device is mandatory [233, 234]. Furthermore, TOE can help determine pharmacological support and pump speed settings while the patient is weaned from CPB, with special attention to the intraventricular septum in the 4-chamber view. Bulging of the intraventricular septum to the left and excessive unloading of the left ventricle (LV) indicate either excessive LVAD speed or RV failure.