Few cardiac surgeons or anesthesiologists would argue with the view that intraoperative echocardiography, both transesophageal and epicardial, has become an important diagnostic tool. Specific diagnostic applications primarily involve valve reconstruction and replacement, as well as complex congenital heart disease repairs. Routine echocardiographic monitoring in cardiac operations is, however, controversial. Three specific modalities may benefit from this technology. Aortic root scanning before cannulation/proximal coronary anastomoses using surface echocardiography is one. Areas with significant atherosclerosis can be identified and manipulation avoided. Another is quantification of global left-ventricular function using transesophageal echocardiography. This method may have specific relevance to patients requiring mechanical circulatory assistance. Using echocardiography to monitor ischemic regional wall-motion abnormalities and using the findings to predict an unfavorable outcome is a third suggested use for perioperative monitoring in cardiac surgery.