Intraoperative Imaging in Aortic Valve Surgery as a Safety Net

In the modern era, the morbidity and mortality of aortic valve surgeries has been markedly reduced. These improvement have been seen in: 1) aortic valve replacement or repair; 2) aortic root replacement or valve-sparing operations; 3) surgery on aortic dissections complicated by aortic regurgitation; and 4) recently introduced transcatheter aortic valve implantations. However, the goal of consistent success without complication is hampered by a number of pitfalls listed in Table 1. While some of these complications are preventable if essential and timely information is obtained, others are rare and unpredictable. For the latter, early diagnosis and the institution of appropriate measures without delay is important in minimizing serious sequelae. For this purpose, intraoperative imaging plays an important role in recognizing the events behind the scenes. This author has exclusively applied transesophageal echocardiography (TEE) and direct echo to aortic valve surgery. The aim of this chapter is to describe the details of echo imaging in aortic valve surgery with a number of tips and case presentations.