Table 5. Frequently Encountered Findings in Preoperative Echocardiography.

Echocardiographic findings	Interpretation
Left atrial enlargement	Degree of left atrial enlargement reflects chronic LV diastolic dysfunction. Patients with left atrial enlargement have an increased risk of atrial fibrillation in postoperative periods.
Diastolic dysfunction	Patients with advanced diastolic dysfunction are prone to develop heart failure in volume overloaded condition ad tachycardia status.
LV hypertrophy	LV hypertrophy itself is not usually problematic, but combined diastolic dysfunction is important (above). However, it should be differentiated from hypertrophic cardiomyopathy or infiltrative myocardial disease.
Regional wall motion abnormalities	Common causes of regional wall motion abnormalities are ischemic heart disease. Myocardial disease, secondary to left bundle branch block, or stress cardiomyopathy should be differentiated from ischemic heart disease.
Systolic dysfunction	LV ejection fraction is a representative indicator for LV systolic function. If a patient has systolic dysfunction, check E/e’ ratio, reflecting LV filling pressure, and right ventricular systolic pressure for evaluation of heart failure status and possibility for the development of decompensated heart failure.
Valvular regurgitation	Intraoperative and postoperative hemodynamic monitoring is reasonable in patients with asymptomatic severe mitral regurgitation and in patients with asymptomatic severe aortic regurgitation and a normal LV ejection fraction.
Valvular stenosis	For patients who meet standard indications for valvular intervention on the basis of symptoms and severity of stenosis, valvular intervention before non-cardiac surgery is effective in reducing preoperative risk.
	Intraoperative and postoperative hemodynamic monitoring is reasonable in patients with asymptomatic severe aortic stenosis and in asymptomatic patients with severe mitral stenosis if valve morphology is not favorable for percutaneous mitral balloon commissurotomy.
Prosthetic valve	All patients with prosthetic valves should receive antibiotic prophylaxis before non-cardiac surgery. Patients with mechanical valves pose a special problem regarding anticoagulation.
Pericardial effusion	The amount of pericardial effusion and presence of hemodynamic significance, such as constrictive physiology or tamponade physiology, are carefully interpreted. Avoiding intracardiac volume depletion and monitoring blood pressure and heart rate are crucial in patients with significant amounts of pericardial effusion.
Pulmonary hypertension	The presence of moderate-to-severe pulmonary hypertension is commonly combined with left heart disease. Elevation of estimated pulmonary venous pressure can be a sign of decompensated heart failure.
	Pulmonary arterial hypertension due to congenital heart disease or idiopathic origin is at a high risk for non-cardiac surgery. If a patient has right ventricular systolic pressure over 50 mmHg, consider invasive hemodynamic monitoring during and after non-cardiac surgery.

LV: left ventricle.