Intraoperative echocardiographic assessment of global and regional myocardial function

Intraoperative echocardiography is gaining increasing importance to the anesthesiologist and the surgeon in the management of high-risk patients undergoing cardiac and major noncardiac surgery. It can provide for the noninvasive, immediate assessment of global left ventricular function, and its determinants; preload, afterload, and myocardial contractility. In addition, abnormalities of regional myocardial function, as a marker of myocardial ischemia, can be easily identified. With the advent of transesophageal echocardiography, this imaging technique can be more widely applied without interfering with the surgical procedure, not only increasing our ability to adequately monitor the patient, but also guiding our therapy and providing additional insights into the physiological and pathophysiological processes affecting the heart during surgery.