Transoesophageal and epicardial echocardiography are indispensible intraoperative imaging modalities to guide paediatric heart disease surgeries and influence surgical decision-making. A less well-described role of intraoperative imaging is its utility in evaluating coronary artery patency and flow. Focused two-dimensional, colour, and spectral Doppler imaging of the coronary arteries should be performed during surgeries involving coronary manipulation or re-implantation, or in cases where there is unexpected ventricular dysfunction or electrographic signs concerning for ischaemia. Intraoperative imaging allows for any anatomical issues to be detected and addressed promptly in the operating room. Imaging of the coronary arteries should identify unobstructed coronary ostia and proximal course without kinking, angulation, narrowing, or significant calibre change to suggest stenosis or extrinsic compression from neighbouring structures. The aim of this review is to highlight the usefulness of transoesophageal and epicardial echocardiography in evaluating coronary artery patency and flow, provide a how-to guide for optimal imaging, and to introduce a practical guideline to achieve best clinical practice.

Pulmonary alveolar proteinosis is often treated with bronchopulmonary lavage. Transoesophageal echocardiography has been used to detect lung atelectasis in critical situations. A 68-yr-old male with pulmonar alveolar proteinosis underwent bronchopulmonary lavage and was examined using transoesophageal echocardiography. His dependent left-lung area was observed through the descending aorta. Following saline infusion, no bright areas containing air were observed. The average area of the air-free region following instillation was 37.4 ± 1.8 cm2, which decreased to 22.8 ± 2.6 cm2 after drainage (P < 0.001). There was a significant relationship between the percentage venous admixture and air-free area during lavage (P < 0.05, r = −0.76). The image of the right lung was unclear. Transoesophageal echocardiography can yield useful information about the lung during bronchopulmonary lavage.

Background and objective Transoesophageal echocardiography is increasingly used for evaluation and monitoring of left ventricular function in anaesthetized patients. However, the only available reference values for transoesophageal echocardiography were derived from studies in awake subjects.

Methods We determined left ventricular dimensions and systolic function in 45 patients without clinical evidence of heart disease who voluntarily underwent transesophageal echocardiography under conditions of balanced general anaesthesia, controlled fluid administration, supine position, muscle relaxation and controlled ventilation.

Results The left ventricular dimensions obtained during these conditions were lower than the published normal values in awake subjects. The indices of global left ventricular function, however, were similar to the normal values obtained by either awake transesophageal echocardiography or transthoracic echocardiography.

Conclusion We propose using the values obtained in our study as reference values for evaluation of left ventricular function in patients under general anaesthesia and controlled ventilation.

We describe a patient with aortic dissection extending into the right coronary artery who was successfully resuscitated and operated upon after a cardiac arrest during transfer to the operating room. The use of transoesophageal echocardiography was particularly helpful for rapid diagnosis of aortic type A dissection and urgent surgical treatment.