Detection of the proximal left and right coronary arteries is possible by transesophageal echocardiography with rather high frequencies. The proximal left coronary artery can be detected in 86% of patients and the proximal right in 82%. Precise identification of obstructive disease is possible but is confounded by heart movement and as yet inadequate criteria for its presence to make this routinely clinically possible. It is also possible to detect flow within these vessels with conventional pulsed or Doppler color flow methods. Given recent improvements in system performance, it is likely that adequate descriptors of proximal coronary anatomy and obstruction will be likely with these approaches.