Real time (RT) three-dimensional (3D) imaging is one of the most significant developments of the last decade and is now being used with increasing frequency in echocardiography and interventional cardiology laboratories. Improvements in transducer technologies and the development of a matrix array transducer were the most important achievements that lead to the new era of real time 3D transoesophageal echocardiography (TEE). RT 3D TEE is ideal for assessing the mitral valve (MV) because of its high spatial resolution altering in improved MV anatomic detail. This imaging modality provides images of high quality which is of a great clinical value inmaking diagnosis of MV disease and a valuable tool for surgeons and interventional cardiologists in planning and guiding interventional procedures. This review is intended to provide data about normal MV anatomy and clinical usefulness of RT 3D TEE in defining acquired MV pathology.
 Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) 1; European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2012 Oct;33(19):2451-96.
 Von Ramm OT, Smith SW. Real time volumetric ultrasound imaging system. J Digit Imaging 1990;3:261-6.
 Sheikh K, Smith SW, von Ramm OT, Kisslo J. Real-time, three-dimensional echocardiography: feasibility and initial use. Echocardiography 1991;8:119-25.
 Yang HS, Bansal RC, Mookadam F. Practical guide for three-dimensional transthoracic echocardiography using a fully sampled matrix array transducer. Jam Soc Echocardiogr 2008;21:979-89.
 Flachskampf FA, Badano L, Daniel WG, Feneck RO, Fox KF, et al. Recommendations for transoesophageal echocardiography: update 2010. Eur J Echocardiogr 2010;11:557-76.
 Lang R, Badano L, Tsang W. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr 2012;25:3-46.
 Salcedo E, Quaife R, Seres T, Carrol J. A framework for systematic characterization of the mitral valve by real time three dimensional transesopfageal echocardiography. J Am Soc Echocardiogr 2009;22:1087-99.
 Barlow JB. Perspectives on the mitral valve. Philadelphia, Pa: F.A. Davis; 1987.
 Van Mieghem N, Piazza N, Anderson R, Tzikas A, Nieman K, et al. Anatomy of the mitral valvular complex and its implications for transcatheter interventions for mitral regurgitation. J Am Coll Cardiol 2010;56:617-26.
 Carpentier A. Cardiac valve surgery: the ‘French correction’. Journal of Thoracic and Cardiovascular Surgery 1983;86(3):323-37.
 Kumar N, Kumar M, Duran CMG. A revised terminologyfor recording surgical-findings of the mitral valve. Journal of Heart Valve Disease 1995;4(1):70-5.
 Silbiger JJ, Bazaz R. Contemporary insights into the functional anatomy of the mitral valve. Am Hear J 2009;158(6):887-95.
 Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, et al. Burden of valvular heart disease: a population based study. Lancet 2006;368:1005-11.
 Lung B, Baron G,Messika-Zeitoun D, Detaint D, Vanoverschelde JL, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Disease. Eur Heart J 2003;24:1231-43.
 Chandra S, Salgo I, Sugeng L, Weinert L, Tsang W, et al. Characterization of degenerative mitral valve disease using morphologic analysis of real-time three-dimensional echocardiographic images: objective insight into complexity and planning of mitral valve repair. Circ Cardiovasc Imaging 2011;4:24-32.
 Filsoufi F, Carpentier A. Principles of reconstructive surgery in degenerative mitral valve disease. Semin Thorac Cardiovasc Surg 2007;19:103-10.
 Cotran RS, Kumar V, Collins T. Robbins pathologic base of disease. 6th ed. Philadelphia, Pa: W.B. Saunders Company; 1999. Chapter 13, p. 569-72.
 Faletra FF, de Castro S, Pandian NG. Atlas of real time 3D transesophageal echocardiography. Berlin: Springer- Verlag; 2010.
 Pan M, Medina A, Suarez de Lezo J, et al. Factors determining late success after mitral balloon valvulotomy. Am J Cardiol 1993;71(13):1181-5.
 Wilkins GT,Weyman AE, Abascal VM, et al. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Hear J 1988;60(4):299-308.
 Soliman OII, Anwar AM, Metawei AK, McGhie JS, Geleijnse ML, Ten Cate FJ. New scores for the assessment ofmitral stenosis using real-time three-dimensional echocardiography. Curr Cardiovasc Imaging Rep 2011;4:370-7.
 Sutaria N, Shaw TR, Prendergast B, Northridge D. Transesophageal echocardiographic assessment of mitral valve commissural morphology predicts outcome after balloon mitral valvotomy. Heart 2006;92:52-7.
 Carpentier A, Adams D, Filsoufi F. Carpentier’s reconstructive valve surgery. Philadelphia, Pa: Saunders; 2010. p. 116-8.
 Anwar A, et al. True mitral annulus diameter is underestimated by two dimensional echocardiography as evidenced by real-time three-dimensional echocardiography and magnetic resonance imaging. Int J Cardiovasc Imaging 2007;23:541-7.
 Ender J, Koncar-Zeh J, Mukherjee C, Jacobs S, Borger MA, et al. Value ofaugmented reality-enhanced transesophageal echocardiography (TEE) for determining optimal annuloplasty ring sizeduring mitral valve repair. Ann Thorac Surg 2008;86:1473-8.
 Faletra FF, Moschovitis G, Auricchio A. Visualisation of thrombus formation on prosthetic valve by real-time three-dimensional transoesophageal echocardiography. Heart 2009;95:482.
 Kronzon I, Sugeng L, Perk G, Hirsh D, Weinert L, Garcia Fernandez MA, Lang RM. Real-time 3-dimensional transesophageal echocardiography in the evaluation of post-operative mitral annuloplasty ring and prosthetic valve dehiscence. J Am Coll Cardiol 2009;53:1543-7.
 Fischer G, Adams D. Real-time three-dimensional TEE guided repair of a paravalvular leak after mitral valve replacement. Eur J Echocardiogr 2008;9:868-9.
 Biner S, Rafique AM, Kar S, Siegel RJ. Live threedimensional transesophageal echocardiography-guided transcatheter closure of a mitral paraprosthetic leak by Amplatzer occluder. J Am Soc Echocardiogr 2008;21:1282.e7-9.
 Faletra F, et al. Role of real-time three dimensional transoesophageal echocardiography as guidance imaging modality during catheter based edge-to-edge mitral valve repair. Heart 2013;0:1-12.
 Colli A, et al. TEE-guided transapical beating-heart neochord implantation in mitral regurgitation. JACC Cardiovasc Imaging 2014;7(3):322-3.