Fig. 1. The main echogenic patterns during total knee arthroplasty with the transesophageal echocardiography in upper esophageal plane. (A ) Grade 0: no emboli. LA = left atrium; RA = right atrium; SVC = superior vena cava; IVC = inferior vena cava. (B ) Grade 1: a few fine emboli (arrow). This picture is the image observed after femoral reaming in the tourniquet use group. (C ) Grade 2: embolic masses less than 5 mm in diameter (arrow) with fine masses. This picture is the image observed after femoral reaming in the tourniquet group. (D ) Grade 3: large embolic masses greater than 5 mm in diameter (arrow) with fine masses. This is the image observed after prosthesis with a long-stem insertion into the femur in the tourniquet group.