Simultaneous transesophageal echocardiography and atrial pacing: assessment of the functional significance of coronary artery disease before surgical treatment of an abdominal aneurysm.

Conventional active stress tests for the evaluation of coronary artery disease are not feasible for patients in whom a significant blood pressure increase during a stress procedure should be avoided, for example, those with a coexisting aortic aneurysm. Transesophageal echocardiography (TEE) with simultaneous atrial pacing is a new, highly specific, and sensitive stress technique for the detection of coronary artery disease. Furthermore, TEE can be performed safely with only mild blood pressure increases. Therefore in the present case report of a 70-year-old male, application of combined TEE and atrial pacing was used successfully to exclude the hemodynamic significance of a circumflex artery stenosis and avoided a significant blood pressure increase before surgical correction of an abdominal aortic aneurysm.