For the purpose of the study, we will document carefully what impact the hTEE assessment has on the management plan on the first 60 patients who meet criteria and compare results to the standard of care use of CVP/ Echocardiography combination in terms of clinical decision making. Subsequent hTEE assessments will be made sequentially as clinically indicated, and the information obtained will be analyzed in the same way. All images will be stored for clinical interpretation on the machine itself, which is accessible to authorized personnel only. All patient data that is collected for the study will be coded; No subject identifiers will be recorded on study forms. See the privacy and confidentiality section for details.