Transesophageal Echocardiography in Transcatheter Mitral Valve Replacement.

Transesophageal echocardiography (TEE) has emerged as the pivotal imaging modality in transcatheter mitral valve replacement (TMVR), bridging the gap between anatomical complexity and procedural precision. Unlike any other tool, TEE accompanies the patient journey across all stages of TMVR, from patient assessment and device selection to intraprocedural guidance and post-implant surveillance, providing real-time insights into valve anatomy, hemodynamics, and complications. This review consolidates the most recent consensus statements, quantitative thresholds, and device-specific considerations, while also highlighting evolving technologies. By outlining best practices for integrating TEE within multimodality workflows and the Heart Team paradigm, this article offers clinicians a comprehensive and practice-oriented roadmap for optimizing TMVR outcomes.