In all, 4–10% of tumor thrombus in renal cell carcinoma (RCC) extends into the inferior vena cava (IVC). When the thrombus extends into the right atrium (RA), it becomes surgically challenging; and depending on its extension and adherence to the underlying structure, it may need cardiopulmonary bypass (CPB). The utility of transesophageal echocardiography (TEE) is reviewed for the management of RCC with cavoatrial extension. Intraoperative TEE is an essential modality in cases of RCC with level IV tumor thrombus, and in cases that require CPB with or without deep hypothermic circulatory arrest (DHCA). Intraoperative TEE provides us real-time information about thrombus staging in addition to the properties of the thrombus, such as adherence and fragility. Intraoperative TEE can also be used to assess cardiac function, fluid status, real-time monitoring of thrombus including embolization while manipulation and to ensure no residual thrombus. We therefore recommend the use of intraoperative TEE in RCC with level IV tumor thrombus. In the future, more research is needed to demonstrate the impact of intraoperative TEE on morbidity, mortality, and complication rate of the procedures.

Chronic constrictive pericarditis (CCP) is a condition in which thickened, noncompliant pericardium encases heart structures. Association of right atrial (RA) thrombus in CCP imparts some challenges during the perioperative period. Perioperative echocardiography plays a vital role in managing this group of patients. This case series highlights the importance of perioperative echocardiography in managing the patients who had CCP with RA thrombus.

Myxomas are the most common type of tumors of the heart and account for 83% of the primary tumors. The left atrium (LA) is the most common site for myxoma, followed by the right atrium. Obstructive symptoms of myxomas can mimic as mitral stenosis, and the severity increases due to an increase in heart rate such as the development of atrial fibrillation (AF). There is a high probability of developing pulmonary artery hypertension and right ventricular (RV) failure in patients with long-standing LA myxomas which can further be complicated by the development of AF. As the majority of patients with LA myxomas present late due to their nonspecific symptoms, a thorough assessment of pulmonary artery hypertension and RV function assessment should be done before surgical intervention.

Transesophageal echocardiography (TEE) is invaluable in identifying the exact mechanism of prosthetic valve dysfunction (PVD), which may help in the proper management of patient. Here, we report a case of severe mitral regurgitation due to flail mitral valve leaflet resulting from torn bioprosthetic cusp where TEE was instrumental in demonstrating the exact mechanism of valve dysfunction.

The left atrial appendage (LAA) considerably varies in morphology and position. In rare cases, it can be juxtaposed on the right side. Here, we present the transesophageal echocardiography (TEE) images and surgical findings of two patients presenting for corrective surgery of their underlying congenital cardiac anomalies. While abnormal position of the LAA was detected in the first patient, juxtaposition of LAA was detected in second patient by TEE and confirmed intraoperatively.

Temporary pacing acts as an essential modality for maintaining hemodynamic stability in some life-threatening arrhythmias developed after cardiac surgery. We hereby discuss a case of partial balanced atrioventricular septal defect (AVSD) in which temporary pacemaker acted as a potential pitfall in the assessment of mitral regurgitation (MR). This case highlights the impact of pacing mode on MR severity and hence influencing perioperative decision-making after intracardiac repair.

Perioperative echocardiography is a useful guide in the management of hemodynamically unstable patients. We, hereby, describe a case of massive pericardial effusion with interesting images on echocardiography.