This chapter focuses on isochemic heart disease (IHD) and an intervention-related analysis, combining all the utilities of transesophageal echocardiography (TEE) in a systematic approach towards the patient undergoing coronary artery bypass grafting (CABG) surgery. Patent foramen ovale (PFO) is the most frequently reported new diagnosis. It is a common observation in about 25% of postmortem studies, and TEE is able to detect it with about the same frequency in the clinical setting. TEE is a highly accurate method for identifying atrial thrombus. In most patients scheduled to undergo elective CABG surgery, the presence of mitral valve (MV) disease is well documented. The hallmark of myocardial ischemia is regional heterogeneity in the extent and time course of systolic wall motion. Intraoperative TEE is required for mitral valve repair during left ventricular (LV) restoration surgery, but caution should be exercised in grading the severity of mitral valve regurgitation.