Myocardial ischemia detected by transesophageal echocardiography in a patient undergoing peripheral vascular surgery

Prevention and early treatment of myocardial ischemia remain among the prim ary goals of the anesthesiologist taking care of high-risk patients, such a s those undergoing vascular surgery. Guidelines have been published to assi st in directing preoperative evaluation and optimization of cardiovascular status. Although perioperative monitoring allows early detection of ischemi c events, all monitors have limitations that must be understood before they can be used effectively. We present a case of severe intraoperative myocar dial dysfunction detected only by transesophageal echocardiography in a pat ient undergoing a peripheral vascular procedure. Preoperative and intraoper ative management is also discussed. (C) 2000 by Elsevier Science Inc.