[Intraoperative transesophageal echocardiography].

Transesophageal echocardiography (TEE) is an essential tool for all the cardiovascular surgeries. It has many roles intraoperatively including confirmation of preoperative diagnosis, guiding cannulation for cardiopulmonary bypass, monitoring myocardial contractility as well as loading conditions, helping the surgeon to evacuate residual intracardiac air after cardiotomy, and ensuring successful surgical results after coming off from cardiopulmonary bypass. Since TEE probe is placed very close to the left atrium, much more detailed images of the heart can be obtained by TEE than by transthoracic echocardiography. To fully utilize TEE, you need to be familiar with ultrasonography physics, common artifacts, and basic images. When performing TEE examination in anesthetized patients, you should be extremely careful to avoid TEE-related complications such as esophageal perforation, endotracheal tube displacement, and hemodynamic/ventilatory disturbance. It requires a lot of expertise to be able to make full use of TEE. The amount and quality of information which can be obtained from TEE are heavily operator-dependent. Therefore, continuous efforts to improve the skill and quality assurance are mandatory. An annual qualifying exam for TEE is available from the Japanese Society of Cardiovascular Anesthesia.