False negative transesophageal echocardiography in a patient with severe mitral regurgitation

We present a patient with severe mitral regurgitation, diagnosed by cardiac catheterization and physical examination but not seen on transesophageal echocardiography (TEE) after general anesthesia. Subsequently, transthoracic echocardiography was performed with the regurgitant jet visualized. This case illustrates one of the limitations of TEE secondary to the use of a biplane probe. The availability and routine use of an omniplane probe may prevent this limitation. A complement of physical examination, imaging, and diagnostic tools, as well as thorough understanding of the limitations of each technique, is essential.