Acute type A aortic dissection represents a critical cardiac surgical emergency and carries a significant mortality risk. While computed tomography angiography is the standard for initial diagnosis, transesophageal echocardiography (TEE) is indispensable in the intraoperative setting. This article discusses intraoperative TEE findings in patients undergoing surgery for type A aortic dissection, emphasizing the necessity of real-time imaging to detect complications and guide surgical management. The use of TEE is important in confirming diagnoses, monitoring hemodynamics, evaluating the function of the aortic valve, pericardial, and pleural spaces, and potentially assessing abdominal branch vessel flow, thus ultimately facilitating informed surgical decisions.