Objective The present study aims to evaluate the value of three-dimensional transesophageal echocardiography with xPlane imaging technology（3D-TEE-xPlane） in the location and grading of mitral valve prolapse.Methods A total of 92 patients with mitral valve prolapse who had underwent mitral valve replacement or plasty at Wuhan Asia Heart Hospital from January 2018 to January 2021 were selected.All patients underwent standard two-dimensional transthoracic echocardiography（2D-TTE） and 3D-TEE-xPlane echocardiography.With surgical exploration as the gold standard，comparative analysis of the sensitivity，specificity，accuracy，positive and negative predictive rate of 2D-TTE and 3D-TEE-xPlane in assessing the location of mitral valve prolapse.Results Compared with 2D-TTE，the sensitivity of 3D-TEE-xPlane in A1，A2，P1，P2 area prolapse recognition is improved（64.7% vs 94.1%，73.7% vs 100%，64.7% vs 94.1%，82.2% vs 97.8%），the specificity of 3D-TEE-xPlane in A1，A2，A3，P1，P2 and P3 area prolapse recognition is improved（90.7% vs 98.7%，90.4% vs 98.6%，90.9% vs 98.7%，92.0% vs 100%，89.4% vs 100%，87.7 vs 98.5%），the accuracy of 3D-TEE-xPlane in A1，A2，A3，P1，P2 and P3 area prolapse recognition is also improved（85.9% vs 97.8%，87.0% vs 98.9%，87.0% vs 97.8%，87.0% vs 98.9%，85.9% vs 98.9%，84.8% vs 97.8%），the positive predictive value of 3D-TEE-xPlane in A1，A2，A3，P1，P2 and P3 area prolapse recognition is also improved（61.1% vs 94.1%，66.7% vs 95.0%，58.8% vs 93.3%，64.7% vs 100.0%，81.1% vs 100.0%，72.4% vs 96.3%），the negative predictive value of 3D-TEE-xPlane in A1and A2 area prolapse recognition is also improved（93.0% vs 100%，84.0% vs 97.9%）（all P＜0.05）.Compared with intraoperation，2D-TTE has moderate consistency in identifying mitral valve prolapse in A1，A3，and P1 areas （A1=0.541, A3=0.546, P1=0.567）；and has strong consistency in identifying other leaflet prolapses（A2=0.617, P2=0.717, P3=0.641）.However，the diagnosis were strong consistent with intraoperation by 3D-TEE-xPlane in the recognition of the prolapsed leaflets（A1=0.928, A2=0.967, A3=0.920,P1=0.963,P2=0.978, P3=0.948）（all P＜0.05）.Conclusion 3D-TEE-xPlane imaging is an accurate，easy-to-use and easy-to-interpret imaging method that can assess the location of mitral valve prolapse more accurately.