Echocardiography plays a central role in modern practice of cardiology. The diagnostic capabilities of this technique have evolved tremendously over the last three decades. From an anatomic and quantitative standpoint, the recent introduction of real time three dimensional (3D) imaging in association with transesophageal echocardiography (TEE) has greatly facilitated identification of cardiac pathology, decision making regarding the best therapeutic approach, and communication of the findings with interventionists and cardiothoracic surgeons. It has also offered a means of properly monitoring percutaneous interventions and results of surgical repair. This review provides a summary of a recent patent, current clinical application, and future potentials of real time 3D TEE in the general practice of adult cardiovascular disease.