Transesophageal echocardiography (TEE) can be particularly helpful when transthoracic echocardiography (TTE) is not practical or nondiagnostic. The majority of indications for TEE are in settings when this is the case. TEE is a relatively safe procedure with a combined complication rate around 0.5% and mortality rate of <0.01%. There are few absolute contraindications to TEE but they include severe esophageal pathology such as perforation, strictures, diverticula, or active bleeding. Considerations for probe insertion include patient positioning, level of sedation, placement of bite block, and probe positioning. Standardized terminology allows for the discussion of systematic manipulation of the TEE probe.