Although transthoracic two-dimensional echocardiography can detect dilation of the coronary arteries, the reliability of this technique in the detection of coronary artery stenosis is still doubtful. The purpose of this study was to test the ability of newly developed biplane transesophageal color Doppler and two-dimensional echocardiography in the detection of left main coronary artery stenosis. Blood flow in the left main coronary artery was detected in 57 of 67 (85%) patients by transesophageal color Doppler flow imaging. Using transesophageal two-dimensional echocardiography, adequate images of the full length of the left main coronary artery and identification of the bifurcation were obtained in 60 of 67 (90%) patients. Transesophageal echocardiography clearly showed significant (greater than or equal to 50%) narrowing of the coronary lumen in 10 of 11 patients (sensitivity, 91%) and insignificant narrowing or no abnormalities of the coronary lumen in the other 49 patients (specificity, 100%). The positive predictive accuracy for left main coronary artery disease was 100%, and the negative predictive accuracy was 98%. This preliminary study suggests that biplane transesophageal color Doppler and two-dimensional echocardiography appears to be a feasible noninvasive technique for imaging the left main coronary artery and detecting hemodynamically significant luminal obstruction.