Newest 3D software allows measurements directly in the en-face-3D TEE mode. Aim of the study was to ascertain whether measurements performed in the en-face-3D TEE mode are comparable with conventional measurement methods based on 2D TEE and 3D using the multiple plane reconstruction mode with the Qlab^® software. En-face-3D TEE is used more frequently in daily clinical routine during cardiac operations. So far measurements could only be done based on 2D images or with the use of multi planar reconstruction mode with additional software. Measurement directly in the 3D image (en-face-3D TEE) would make measurements faster and easier to use in clinical practice. After approval by the local ethic committee and written informed consent from the patients additionally to a comprehensive perioperative 2D TEE examination a real time (RT) 3D zoom- dataset was recorded. Routine measurements of the length of anterior and posterior mitral valve leaflets as well as mitral valve and aortic valve areas were performed in en-face-3D TEE, multiplanar reconstruction mode using Qlab^®-software (Philips, Netherlands) and 2D TEE standard views. Twenty nine patients with a mean age of 67 years undergoing elective cardiac surgery/interventions were enrolled in this study. Direct measurements in en-face-3D TEE mode lead to non significant underestimation of all parameters as compared to Qlab^® and 2D TEE measurements. Measurements in en-face-3D TEE are feasible but lead to non significant underestimation compared to measurements performed with Qlab^® or in 2D TEE views.