37 Supine

exercise, handgrips, upright bicycles and cold pressor tests were used in early studies.38 But the great advance was the ability of recording stress-induced WMA during treadmill exercise. Subsequently pharmacological agents and cardiac pacing were also used to induce ischemic WMA. Transesophageal Echocardiography The first experimental probes with the potential utility for TEE were established Inhibitors,research,lifescience,medical in the 1970s.11 TEE was first performed in 1980 by putting a two-dimensional transducer on a fiberoptic endoscope.39 After that, a phased-array ultrasound transducer was attached to the tip of a flexible gastroscope by Hanrath and colleagues,40 and TEE entered its modern era.11 With early monoplane transesophageal probes, only transverse images via a limited field of view were obtainable. Better imaging of the heart was achieved after the development of smaller probes with biplane and particularly multiplane imaging

capabilities. Therefore, Inhibitors,research,lifescience,medical the diagnostic field of TEE has increased greatly (figure 2). The semi-invasive BYL719 datasheet nature of TEE allowed progressive uses in both Inhibitors,research,lifescience,medical inpatient and outpatient settings. Figure 2 Transesophageal echocardiography (0 degree) shows a 4-chamber view at mid esophageal level. RA: right atrium, LA: left atrium, RV: right ventricle, LV: left ventricle Intraoperative Echocardiography Intraoperative echocardiography is being used by the epicardial and/or transesophageal approach. Inhibitors,research,lifescience,medical The first use of epicardial

echocardiography using the M-mode technique was done in the operating theater to evaluate the results of open mitral commissurotomy in 1972.41 However, it was used routinely only after the widespread application of transesophageal echocardiography combined with color-flow imaging. “The ability to monitor cardiac performance led to the early acceptance of transesophageal echocardiography to monitor changes in ventricular function and hemodynamic measures during cardiac surgery”.11 Inhibitors,research,lifescience,medical Before cardiopulmonary bypass (CPB), it helps to establish the cardiac structural and functional abnormalities and to search for additional or sometimes neglected findings which may change the surgical plan in the operative room.42-44 After CPB, it provides assessment of the surgical results and even new abnormalities which may need second run. Furthermore operative complications would be reduced by intraoperative monitoring GSK690693 clinical trial of LV function and detecting cardiovascular causes responsible for hemodynamic instability in the operating room which may cause difficulty to off pump. In hemodynamically unstable patients the cause of hemodynamic compromise can be determined and intraoperative complications would be identified. Importantly, before leaving the operating room the adequacy of valve repairs (or replacements) and surgical correction of congenital defects can be evaluated.