TEE

Absolute contraindications:
Esophageal spasm.
Esophageal stricture.
Esophageal laceration.
Esophageal perforation.
Esophageal diverticula (e.g. Zenker's diverticulum).

Relative contraindications:
Large diaphragmatic hernia may significantly hinder TEE imaging because of lack of transducer mucosal approximation.
Atlantoaxial disease and severe generalized cervical arthritis: TEE should never be performed if there is any question about stability of cervical spine.
Patients who received extensive radiation to the mediastinum: this can cause significant difficulty in probe manipulation within the esophagus and is a relative contraindication if the anatomy of the esophagus is not known.
Upper gastrointestinal bleeding, significant dysphagia and odynophagia are also relative contraindications

Indication:
cardiac output
valve
congenital heart disease
evaluation of LA and LA appendage before cardioversion