The purpose of this study was to test the efficacy of newly developed biplane transesophageal color Doppler and two-dimensional echocardiography in the evaluation of coronary artery anatomy and blood flow. Using these two techniques, high quality images of the entire main left coronary artery (from the left coronary ostium to the bifurcation of the left anterior descending and circumflex coronary arteries), adequate for assessment of luminal diameter and percent stenosis, were obtained in 34 (89%) out of 38 patients. Transesophageal color Doppler echocardiography visualized coronary blood flow in 32 (84%) of the 38 patients. Transesophageal two-dimensional echocardiography clearly showed significant (50% of greater) narrowing of the coronary lumen in 10 out of 12 patients (sensitivity; 83%) and insignificant narrowing or no abnormalities of the coronary lumen in 23 of 26 normal individuals (specificity; 88%). This preliminary study suggests that biplane transesophageal color Doppler and two-dimensional echocardiography are feasible, noninvasive techniques for imaging the main left coronary artery and blood flow.