Perioperative transesophageal echocardiography (TEE) has gradually become an essential intraoperative imaging modality, evolving from being used as a hemodynamic monitor to becoming an important procedural adjunct. Minimally invasive approaches for structural heart diseases have gained wider popularity due to advances in cardiac surgery, thereby making TEE imaging an integral component of intraoperative decision-making. Although traditional two-dimensional (2D) TEE provides a dynamic display of cardiac anatomy, it is spatially limited. Recent technological advances have allowed for the development of three-dimensional (3D) TEE. Currently, 3D imaging is mainly used for qualitative imaging of intra-cardiac structures and the data has been used for 3D printing of intra-cardiac structures. It has also demonstrated value in quantitative analyses of structural heart diseases and hemodynamic calculations. 3D imaging is gaining widespread popularity due to its useful applicability, allowing anesthesiologists to expand their role as perioperative physicians.