Reconstructive surgery of the aortic valve is being increasingly used in patients with aortic regurgitation and/or aortic aneurysm. Its success depends on restoring normal aortic valve and root form. Echocardiography is the most reliable and precise imaging technique because it defines abnormal morphology and function, essential for selecting appropriate substrates and guiding the surgical strategy. Despite technical advances in echocardiography, aortic valve and aortic root morphology and function are still assessed mainly using 2-dimensional echocardiography in clinical practice. This review focuses on the need to use 3-dimensional echocardiography to characterize different forms of aortic valve and root abnormalities and attempts to define echocardiographic predictors of successful valve-root complex repair. Display omitted •Reconstructive surgery of the aortic valve has currently received increasing attention in patients with aortic regurgitation and/or aortic aneurysm.•The use of 3D echocardiography is a powerful tool to objectively characterize different forms of aortic valve and root abnormalities and to define echocardiographic predictors of successful valve/root complex repair.•The systematic analysis of the aortic root by 3D echocardiography enables correct planning of surgical procedures in reconstructive surgery in patients with aortic regurgitation and aortic valve/root abnormalities.•Automatic quantification of the aortic root complex and image optimization by further technical improvements will facilitate the dynamic analysis of the aortic root complex by echocardiography in the future.