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The assessment of cardiovascular hemodynamics is an extremely important component of managing patients with cardiac diseases. For years, this has been accomplished primarily through the use of right and left heart catheters placed within the cardiac chambers. Since this is an invasive technique, it should only be used when necessary; patient discomfort, infections, and overall risks for physicians would be reduced if noninvasive methods were utilized when available. Echocardiography (echo) provides the greatest ability to determine cardiovascular hemodynamics noninvasively, but requires the utmost precision and care to avoid misinterpretation. When used correctly, echocardiographic modalities provide an even greater assessment of the cardiac patient than invasive techniques. A safer and more comprehensive interpretation is available, and thus, echo should be considered the modality of choice-the new gold standard.

Coronary artery imaging is routinely obtained invasively at cardiac catheterization through coronary angiography. This remains the gold standard, but with advances in ultrasound technology, electron beam computed tomography, and magnetic resonance imaging, newer noninvasive methodologies are achieving greater success at imaging the coronary anatomy. This review is meant to highlight the important accomplishments from transesophageal echocardiographic (TEE) investigations that have studied the coronary arteries. The specific technique for optimally imaging the coronaries with high frequency transducers, color and conventional Doppler, in addition to contrast-enhanced methods, will be analyzed. Importantly, this article serves as a reminder to echocardiographers and cardiologists that excellent, clinically relevant information of the coronary arteries can be obtained routinely during TEE. This technique is part of the trend noted by the other authors in this special edition; that is, echocardiography is becoming the gold standard of the new millennium for many diagnostic areas, even coronary angiography.