Perioperative echocardiography

Perioperative echocardiography is one of the fastest growing areas of echocardiography. Although transthoracic imaging has a role, intraoperative imaging is mostly undertaken using transoesophageal echocardiography (TOE).The indications for perioperative echo have recently been re-evaluated, resulting in recognition of the ubiquitous benefit in patients undergoing cardiac surgery, and recognition of the value in non-cardiac surgery and critical care also.Although TOE is safe, it should be remembered that there may be a greater risk of traumatic damage to the soft tissues in anaesthetized patients who cannot complain of pain during probe insertion.Perioperative imaging should be used to confirm and refine the preoperative diagnosis, detect new or unsuspected pathology, adjust the anaesthetic and surgical plan, and assess the results of surgical intervention. Using imaging to optimize myocardial function is a constantly developing technique, and one which may ensure that patients leave the operating room in the best possible condition. The use of perioperative echo in some procedures, for example, in mitral repair, is now regarded as so valuable that it is arguable that perioperative TOE should be mandatory in these cases.