Novel use of transesophageal echocardiographic probe for intraoperative epicardial imaging

We studied 3 patients in whom standard transesophageal echocardiography was either not feasible nor offered suboptimal images. A standard multi-plane transesophageal echocardiography probe was covered in a sterile sheath containing ultrasonic gel, and the tip of the probe was placed on the beating heart by the surgeon. Echocardiographic imaging planes were selected by combining multi-plane imaging with "flexion" and "extension" of the probe by the echocardiographer, with minimal surgical manipulation. Good-quality "epicardial-transesophageal echocardiography" images were obtained in all cases, allowing effective decision-making by the surgeon. The small size of the probe and availability of multi-plane imaging allowed comprehensive and detailed imaging of the heart with minimal manipulation of the probe. There were no side effects attributable to the epicardial-transesophageal echocardiography. The new technique of epicardial echocardiography with a multi-plane transesophageal echocardiography probe overcomes the limitations of conventional transesophageal echocardiography and of epicardial echocardiography in selected patients and allows excellent visualization of cardiac structure and function with minimal interference with the surgical field, and with no extra expenditure.