Value of Intraoperative Transesophageal Echocardiography in Preventing Serious Complications during Valvular Surgery. A Report of Four Cases
Hiromichi Fujii MD, Shigefumi Suehiro MD, Toshihiko Shibata MD, Koji Hattori MD, Hiroyuki Watanabe MD, Junichi Yoshikawa MD

The value of intraoperative transesophageal echocardiography (TEE) is justified by the detection of rare and potential serious complications undergoing valvular surgery. In case 1, one leaflet of an implanted bileaflet artificial valve in the mitral position was stuck in the closed position; normal valve function was restored by 90° rotation. In case 2. moderate regurgitation was observed after mitral valve replacement with a bioprosthesis; regurgitation proved to be due to a suture loop jamming. In case 3, perivalvular leakage was detected after aortic valve replacement for infectious endocarditis; an additional suture stopped the leakage. In case 4, a foreign body was observed in the left atrium after aortic valve replacement for calcified aortic stenosis; the left atrium was re-opened, and a free-floating portion of the calcified native valve identified and removed. Routine intraoperative TEE in valve surgery permits the identification and management of potential serious complications prior to discontinuing cardiopulmonary bypass.