Aortic inner surface morphology in various pathologies was investigated using three-dimensional (3D) transesophageal echocardiography to clarify the feasibility and limitations for clinical application. Transesophageal echocardiography was performed in 16 patients with aortic disease (12 aortic dissection, 4 aortic sclerosis) and 5 with normal aorta. The transesophageal transverse view of the descending aorta was taken every 2 mm by manually withdrawing the probe. Each image was recorded using VTR during one heart beat, then stored in the memory of a personal computer as a data base for the subsequent 3D reconstruction. The aortic inner surface was displayed using distance and gradient shading. Three-dimensional reconstruction images were obtained in all patients. The aortic inner surface was reconstructed as a wall with ringed protrusion in patients with normal aorta and a rugged wall with various sized protrusions in patients with atherosclerotic plaques by 3D transesophageal echocardiography. However, it was impossible to differentiate calcified lesions from non-calcified areas of plaques. In aortic dissection, 3D reconstruction provided information regarding the spatial anatomy of the dissection in 10 of 12 patients, accurate shape and location of the intimal tears in 3 of 5 patients, and movement of the intimal flap in 9 of 12 patients. However, reconstruction of the false lumen failed in two patients who had false lumens filled with spontaneous contrast echo. Three-dimensional transesophageal echocardiography is potentially useful for estimating the inner surface morphology and spatial extent and actual location of the aortic abnormalities, but there are limitations in evaluating tissue characterization and reconstructing the lumen with spontaneous contrast echo.