ObjectiveThe conventional mid‐esophageal observation by three‐dimensional transesophageal echocardiography (3DTEE) sometimes fails to visualize the subvalvular apparatus. In this study, we compared the effectiveness of the transgastric approach by 3DTEE in visualizing the mitral valve complex with the conventional mid‐esophageal approach.MethodsWe studied 10 consecutive patients who underwent mitral valve surgery for functional mitral regurgitation. The anatomy of the mitral complex was interpreted from the 3DTEE data acquired by both the mid‐esophageal and the transgastric approach preoperatively. The interpretations of the image of the mid‐esophageal approach and the transgastric approach were compared with surgical observations.ResultsIn the concordance rate for surgical observation, the interpretation of the number of papillary heads and chordal distribution for the transgastric observation were superior to those for the mid‐esophageal observation both for anterior papillary muscle (P < 0.01 and 0.005, respectively) and posterior papillary muscle (P < 0.001 and 0.0005, respectively).ConclusionThe accuracy of transgastric observations of submitral structure using 3DTEE was superior to that provided by the conventional mid‐esophageal approach. Transgastric approach offers a ventricular view and complementary information to conventional mid‐esophageal approach in patient with functional mitral regurgitation.