RESUMO
To evaluate the benefit of peroperative Transesophageal echocardiography [TEE] during cardiac surgery. An observational analytic study. This study was carried out in the department of Cardiac Surgery Civil Hospital, Dow Medical College Karachi and Dow University of Health Sciences, from April 2001 to May 2007. In 385 patients undergoing cardiac surgery, preoperative transesophageal echocardiography was performed according to ASA guidelines. Category I in which TEE considered useful, and category 11 are those where TEE is potentially useful but indications are less clear. All TEE examination was reviewed by cardiologist and anesthesiologist. For each patient. the diagnostic decision making and patient care was assessed using three criteria 1] Change in medical therapy; 2] Change in surgical procedure; 3] Confirmation of suspected diagnosis. TEE had greater utility in category I than in category 11 indications 17/70 [25%] versus 57/315 [18%] respectively. The nature of the clinical benefit was as follows: modification of medical therapy in 23/74[31.08%], modification of planned surgical intervention in 49/74[66.2%]. confirmation of a diagnosis in 2/74 [2.70%]. The benefit on therapy was [23.3%] in valvular replacement. [12.6%] in coronary artery bypass surgery and [5%] in congenital heart disease and intracardiac tumors. present study validate the usefulness of the ASA practice guidelines, demonstrating a greater benefit of TEE on clinical management for category I indications than for category II. The TEE was more useful in diagnostic decision making in valvular replacement rather than other procedures