• Hyun Ju Jung, Won-Kyoung Kwon, Sung Jun Lee, Nazri Mohamed, Bo-Mi Shin, Jinyoung Lee, and Tae-Yop Kim.
• Department of Anesthesiology, Uijeongbu St. Mary Hospital, The Catholic University of Korea, Uijeongbu, Gyounggi-do, Korea.
• BMC Anesthesiol. 2016 Oct 4; 16 (1): 83.

BackgroundThis study reports the efficacy of intraoperative transesophageal echocardiography (TEE) for evaluation of high take-off coronary ostia and proximal coronary arterial flows as an alternative to preoperative coronary angiography.Case PresentationIn a 65-year old male undergoing the bicuspid aortic valve (BAV) repair and the extensive remodeling of dilated sinus and tubular junction, and preoperative coronary angiography were unsuccessfully completed due to an allergic reaction to the contrast medium. Intraoperative TEE by employing various 3-dimensional volume images of coronary ostia and Doppler tracings of the coronary arterial flows enabled a thorough pre-procedural evaluation of the high take-off coronary arteries and post-procedural evaluation by confirming the absence of any compromise in coronary arterial flow.ConclusionIn the present case, intraoperative application of various TEE imaging modalities enabled comprehensive evaluation of high-taking off coronary artery, as an alternative to preoperative coronary angiography, in a patient undergoing an extensive aortic valve and aortic root repair procedure.

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