Role of intraoperative transesophageal echocardiography in patients undergoing noncardiac surgery

Major perioperative cardiac complications, including cardiac death, nonfatal myocardial infarction and nonfatal cardiac arrest, can occur in patients undergoing noncardiac surgery. To reduce the risk of these complications, some authors have reported on the utility of intraoperative transesophageal echocardiography as a complementary monitoring tool in noncardiac surgery. However, although this approach is now well established in patients undergoing cardiac surgery, there are no guidelines for intraoperative transesophageal echocardiography application in noncardiac surgery, and little literature exists on patient outcome, logistics, financial impact, medico-legal implications and safety. In this review, we discuss published information about the use of intraoperative transesophageal echocardiography during noncardiac surgery with an attempt to clarify whether this approach may offer potential benefits compared with conventional intraoperative monitoring systems. In addition, perioperative risk determinants in noncardiac surgery are briefly summarized and information derived from intraoperative transesophageal echocardiography for evaluation of cardiac morphology and function is schematically presented.