The potential of transoesophageal echocardiography for preoperative diagnosis of thoracic aorta pathology was evaluated in 15 patients with aortic dissection and 15 patients with aortic aneurysm. The transoesophageal echocardiographic findings were compared with 14 computed tomograms and 21 angiograms. Six patients underwent only transoesophageal echocardiography. All patients were operated upon and the surgical findings were used as a reference for these diagnostic methods. Transoesophageal echocardiography established a complete and correct diagnosis in 27 patients. The diagnosis was partially correct in three patients, all having an aortic dissection. A complete and correct diagnosis was obtained by computed tomography and angiography in 8 and 17 patients, respectively. The results indicated that transoesophageal echocardiography is a sensitive and convenient method for the definitive diagnosis of pathology of the thoracic aorta. It could become the technique of choice in patients suspected of having acute aorta pathology as it enables a rapid and definitive diagnosis at the bedside.

The usefulness of intraoperative epicardial two-dimensional (2D) echocardiography using a commercially available 5 MHz mechanical sector scanner was evaluated in 200 patients. The scanhead was inserted into a gas sterilized plastic bag and placed on the exposed heart. Unsuspected new diagnoses were made in 7 patients. In 68 patients additional morphologic information was obtained. This information influenced surgical management in 32 patients. Intraoperative echocardiographic analysis of the surgical correction revealed the expected results in 184 patients. In 16 patients the investigation provided important information in the decision of immediate reoperation. We conclude that epicardial two-dimensional echocardiography performed by the surgeon familiar with the interpretation of echocardiographic cross-sections yields important information for surgical management. The technique has become an important adjunct in our cardiac surgery department for immediate decision making and leads to optimal results.

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Two patients with classical tricuspid valve atresia were studied by two-dimensional echocardiography before and up to 6 years after Fontan's correction. Preoperative investigation revealed a diminutive right ventricular outflow chamber, which increased in size postoperatively and became functional. These data were compared to those obtained in normal individuals.

The role of intraoperative two-dimensional echocardiography is discussed in 15 consecutive patients with thoracic aorta pathology undergoing cardiac surgery. A 5 MHz mechanical scanner was used before and immediately after cardiopulmonary bypass. In 5 patients intraoperative two-dimensional studies revealed crucial morphologic information which, consequently, had a marked influence on their planned surgical procedure. In 3 patients the findings provided additional information whereas in the remaining patients the intraoperative echocardiographic findings confirmed the preoperative diagnosis. Following surgery the adequacy of cardiac repair was assessed and, in one patient, epicardial echocardiography indicated the necessity for reoperation. The application of intraoperative two-dimensional echocardiography leads to a better understanding of the pathology involved and facilitates a more appropriate decision concerning the surgical procedure.

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We present the apparently unique transoesophageal cross-sectional echocardiographic features of a mycotic aneurysm of the left ventricular outflow tract communicating with an abscess in the anterior free wall of the left ventricle. Precordial echocardiographic studies had been hampered by the interposition of an aortic valve prosthesis.