This paper presents a power-and area-efficient front-end application-specific integrated circuit (ASIC) that is directly integrated with an array of 32 × 32 piezoelectric transducer elements to enable next-generation miniature ultrasound probes for real-time 3-D transesophageal echocardiography. The 6.1 × 6.1 mm² ASIC, implemented in a low-voltage 0.18-μm CMOS process, effectively reduces the number of receive (RX) cables required in the probe's narrow shaft by ninefold with the aid of 96 delay-and-sum beamformers, each of which locally combines the signals received by a sub-array of 3 × 3 elements. These beamformers are based on pipeline-operated analog sample-and-hold stages and employ a mismatch-scrambling technique to prevent the ripple signal associated with the mismatch between these stages from limiting the dynamic range. In addition, an ultralow-power low-noise amplifier architecture is proposed to increase the power efficiency of the RX circuitry. The ASIC has a compact element matched layout and consumes only 0.27 mW/channel while receiving, which is lower than the state-of-the-art circuit. Its functionality has been successfully demonstrated in 3-D imaging experiments.