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BACKGROUND: Detection of myocardial ischaemia during surgery is usually by assessment of regional wall motion using two-dimensional transoesophageal echocardiography (TOE). Tissue Doppler imaging (TDI) may assist this assessment and improve its accuracy. METHODS: We measured peak myocardial velocities in the anterior mid-wall of the left ventricle by TOE and pulsed-wave TDI in addition to transmitral flow velocity, two-dimensional echocardiography and cardiovascular variables. We studied 42 patients before and after coronary bypass surgery with left internal mammary artery grafts. RESULTS: Peak systolic and early and late diastolic velocity measurements of the anterior mid-wall were obtained in all patients. Variation between and within observers was small (<6%). Peak systolic thickening velocity correlated with visual assessment of anterior wall motion score, fractional area change of the left ventricle and left ventricular systolic wall stress. Because of the wide overlap of systolic velocity between the segments with normal and abnormal wall motion, it was not possible to separate normal from abnormal segments on the basis of TDI-derived velocity alone. The diastolic velocity in the anterior wall reflected the transmitral filling pattern. After surgery, the peak systolic and late diastolic anterior wall velocities increased (from 4.2 (95% confidence interval 4.0, 4.7) to 5.7 (4.8, 6.3) cm s(-1) and from 3.5 (3.2, 3.9) to 6.0 (5.1, 6.9) cm s(-1) respectively), while the ratio of early to late diastolic velocity decreased from 1.5 (1.2, 1.7) to 1.0 (0.8, 1.2). TDI changes characteristic of new myocardial ischaemia were not seen in any patient. CONCLUSION: Intraoperative measurement of TDI in the anterior wall of the left ventricle is feasible and provides additional quantitative information on both regional and global systolic and diastolic function. We found changes in myocardial velocities indicating improvement in the systolic and impairment in the diastolic function of the anterior wall of the left ventricle immediately after mammary artery grafting.