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Neil David Hauser and Justiaan Swanevelder

Trans-oesophageal echocardiography (TOE) has become an almost universal intraoperative monitor and diagnostic tool. The use of TOE in most cardiac, aortic, major vascular and transplant operations is used to aid anaesthetic management as well as assist surgical decision-making. In addition to the perioperative environment it is increasingly being used in the Outpatient Department, Emergency Department and Intensive Care settings. In this review we consider the safety associated with the use of TOE, we review the suggested contra-indications and areas that we would consider to TOE to be a necessity. Two case reports at the beginning of the review highlight the need for vigilance and care when utilizing TOE.

Open access

Neil David Hauser and Justiaan Swanevelder

Transoesophageal echocardiography (TOE) has, in certain clinical situations, become an almost universal monitor and diagnostic tool. In the perioperative environment, TOE is frequently used to guide anaesthetic management and assist with surgical decision making for, but not limited to, cardiothoracic, major vascular and transplant operations. The use of TOE is not limited to the theatre environment being frequently used in outpatient clinics, emergency departments and intensive care settings. Two case reports, one of oesophageal perforation and another of TOE utilization in a patient having previously undergone an oesophagectomy, introduce the need for care while using TOE and highlight the need for vigilance. The safe use of TOE, the potential complications and the suggested contra-indications are then considered together with suggestions for improving the safety of TOE in adult and paediatric patients.

Open access

Isaac Adembesa, Adriaan Myburgh and Justiaan Swanevelder


We present a patient with rheumatic heart disease involving all the heart valves. An intraoperative transoesophageal echocardiography confirmed severe mitral stenosis, severe aortic regurgitation, severe tricuspid regurgitation and stenosis, and severe pulmonary stenosis. The patient underwent successful quadruple valve replacement during a single operation at the Groote Schuur Hospital, Cape Town, South Africa.

Learning points:

  • Rheumatic heart disease can affect all the heart valves including the pulmonary valve.

  • Intraoperative transoesophageal echocardiography is key for diagnosis, monitoring and confirmation of successful surgical result during heart valve surgery.

  • Combined surgical procedure of all four valves is possible though associated with long procedural time.