Intra-operative segmental wall motion abnormalities (SWMA) detected by transoesophageal echocardio- graphy (TOE) have been shown to be a sensitive indicator of myocardial ischaemia. To determine the incidence and characteristics of segmental wall motion abnormalities and to relate these changes to peri-operative myocardial ischaemia, biplane TEE, electrocardiogram (ECG) (II + V5) and pulmonary capillary wedge pressure (PCWP) were continuously monitored in 62 consecutive patients with ischaemic heart disease undergoing non-cardiac surgery. Short-axis view at mid-papillary level in transverse scan (T-scan) and long-axis in longitudinal (L-scan) two-chamber view were used for wall motion analysis. New segmental wall motion abnormalities were detected in 16 of 64 patients (25%) using biplane transoesophageal echocardiography. Monoplane transoesophageal echocardiography showed a sensitivity of 75% and a specificity of 100%, electrocardiogram two lead showed a sensitivity of 56% and a specificity of 98%, whereas pulmonary capillary wedge pressure had a sensitivity of 25%, and a specificity of 93% and pressure rate quotient (PRQ) < 1 demonstrated sensitivity of 19% and a specificity of 92% in the detection of myocardial ischaemia. It is concluded that the long-axis view of the left ventricle provides additional information for the detection of segmental wall motion abnormalities. Neither changes in haemodynamic performance nor in electrocardiography leads II and V5 match those of transoesophageal echocardiography for the identification of myocardial ischaemia.