The introduction of transoesophageal echocardiography has provided another acoustic window to the heart and mediastinum. The unique relationship of the esophagus to the heart and thoracic aorta has made transesophageal echocardiography ideal for imaging and assessment of the mitral valve particularly mitral prosthesis, atrial appendages, atrial septum, cardiac masses, aortic valve and thoracic aorta. It is a safe procedure and can be easily performed on patients as an outpatient procedure, on critically ill patients as well as for intraoperative monitoring of left ventricular function and air embolism and intraoperation assessment of cardiovascular surgical procedures.