Intraoperative severity assessment of coronary artery stenosis in patients at risk: The role of transesophageal echocardiography

A 71-yr-old male was scheduled for infrarenal abdominal aortic aneurysm repair. Although he had only minor clinical predictors for increased perioperative cardiovascular risk with > 4 estimated metabolic equivalents for activities, intraoperative transesophageal echocardiography revealed an abnormal maximal-to-prestenotic blood flow velocity ratio in the left main coronary artery. Postoperatively, a severe distal left main coronary artery stenosis was confirmed with coronary angiography. Understanding the flow velocity patterns in the coronary arteries helps the anesthesiologist to detect coronary lesions with transesophageal echocardiography.