{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:29:22Z","timestamp":1787164162863,"version":"build-2736575974"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":36,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The aortic valve (AV) and aortic root complex constitute a functional unit, and their integrated anatomical and dynamic assessment is essential for the management of AV disease. This review highlights the role of three-dimensional echocardiography (3DE) in the comprehensive evaluation of AV disease and its contribution to therapeutic decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Owing to close collaboration with cardiac surgeons, 3DE has significantly expanded the diagnostic information provided by imaging cardiologists and has become a key tool for guiding therapeutic strategies. In patients with significant aortic regurgitation (AR), detailed anatomical assessment of the cusps enables characterization of valve morphology and tissue quality, while multiplanar reconstruction provides accurate measurements of the virtual basal ring, coronary ostial height, and other key anatomical structures. Quantitative assessment of cusp geometry, including effective, geometric, and coaptation heights, allows precise identification of AR mechanisms, thereby facilitating repair-oriented surgical planning. In aortic stenosis (AS), 3DE improves evaluation of discordant or borderline cases through enhanced assessment of the left ventricular outflow tract and direct planimetric measurement of AV area. In addition, 3DE provides complementary information for procedural planning of both transcatheter and surgical AV replacement, particularly in patients with contraindications to computed tomography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Three-dimensional echocardiography, particularly transoesophageal 3DE, has become an essential imaging modality for integrating anatomical and functional information. It improves diagnostic accuracy, supports individualized therapeutic planning, and plays a pivotal role in promoting a repair-oriented approach to the management of aortic valve disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjimp\/qyag136","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T11:56:27Z","timestamp":1786017387000},"source":"Crossref","is-referenced-by-count":0,"title":["Advanced 3D echocardiographic assessment of the aortic valve and aortic root complex: a repair-oriented perspective"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2052-4891","authenticated-orcid":false,"given":"Tommaso","family":"Viva","sequence":"first","affiliation":[{"name":"Department of Clinical Cardiology and Cardiovascular Imaging, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Via Cristina Belgioioso 173 , Milan 20157 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Fiore","sequence":"additional","affiliation":[{"name":"Department of Cardiology, GVM Care & Research, Citt\u00e0 di Lecce Hospital , Lecce ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca","family":"Dulgheru","sequence":"additional","affiliation":[{"name":"Department of Cardiology, GIGA Institute Cardiovascular Science & Metabolism, CHU Sart Tilman, Sart Tilman, University of Li\u00e8ge Hospital , Domaine Universitaire du Sart Tilman, Li\u00e8ge B.35\u20134000 ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Andreini","sequence":"additional","affiliation":[{"name":"Department of Clinical Cardiology and Cardiovascular Imaging, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Via Cristina Belgioioso 173 , Milan 20157 ,","place":["Italy"]},{"name":"Department of Biomedical and Clinical Sciences, University of Milan , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0443-8179","authenticated-orcid":false,"given":"Mattia","family":"Glauber","sequence":"additional","affiliation":[{"name":"Minimally Invasive Cardiac Surgery Unit, IRCCS Ospedale Galeazzi\u2014Sant'Ambrogio , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0804-8194","authenticated-orcid":false,"given":"Patrizio","family":"Lancellotti","sequence":"additional","affiliation":[{"name":"Department of Cardiology, GIGA Institute Cardiovascular Science & Metabolism, CHU Sart Tilman, Sart Tilman, University of Li\u00e8ge Hospital , Domaine Universitaire du Sart Tilman, Li\u00e8ge B.35\u20134000 ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"2026081914163673400_qyag136-B1","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1093\/eurheartj\/ehs443","article-title":"ESC Working Group on Valvular Heart Disease Position Paper-Heart Valve Clinics: organization, structure, and experiences","volume":"34","author":"Lancellotti","year":"2013","journal-title":"Eur Heart J"},{"key":"2026081914163673400_qyag136-B2","doi-asserted-by":"crossref","first-page":"e032532","DOI":"10.1161\/JAHA.123.032532","article-title":"Contemporary valvular mechanisms of aortic regurgitation in tricuspid aortic valves: importance in repair versus replacement strategy","volume":"13","author":"Almaghrabi","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"2026081914163673400_qyag136-B3","doi-asserted-by":"crossref","first-page":"qyaf128","DOI":"10.1093\/ehjimp\/qyaf128","article-title":"Three-dimensional assessment of the mitral valve in clinical practice","volume":"3","author":"Viva","year":"2025","journal-title":"Eur Heart J Imaging Methods Pract"},{"key":"2026081914163673400_qyag136-B4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ehjci\/jer316","article-title":"EAE\/ASE recommendations for image acquisition and display using three-dimensional echocardiography","volume":"13","author":"Lang","year":"2012","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026081914163673400_qyag136-B5","doi-asserted-by":"crossref","first-page":"E119","DOI":"10.1093\/ehjci\/jead090","article-title":"Three-dimensional transoesophageal echocardiography: how to use and when to use\u2014a clinical consensus statement from the European Association of Cardiovascular Imaging of the European Society of Cardiology","volume":"24","author":"Faletra","year":"2023","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026081914163673400_qyag136-B6","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1136\/heart.84.6.670","article-title":"Clinical anatomy of the aortic root","volume":"84","author":"Anderson","year":"2000","journal-title":"Heart"},{"key":"2026081914163673400_qyag136-B7","doi-asserted-by":"crossref","first-page":"i3","DOI":"10.1093\/ejechocard\/jen243","article-title":"Structure and anatomy of the aortic root","volume":"10","author":"Ho","year":"2009","journal-title":"Eur J Echocardiogr"},{"key":"2026081914163673400_qyag136-B8","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1093\/ejcts\/ezz033","article-title":"Variability of repairable bicuspid aortic valve phenotypes: towards an anatomical and repair-oriented classification","volume":"56","author":"De Kerchove","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026081914163673400_qyag136-B9","doi-asserted-by":"crossref","first-page":"244","DOI":"10.21037\/acs-2024-aae-25","article-title":"Aortic root anatomy: insights into annular and root enlargement techniques","volume":"13","author":"Jahanyar","year":"2024","journal-title":"Ann Cardiothorac Surg"},{"key":"2026081914163673400_qyag136-B10","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/0003-4975(91)90966-T","article-title":"The myth of the aortic annulus: the anatomy of the subaortic outflow tracta","volume":"52","author":"Anderson","year":"1991","journal-title":"Ann Thorac Surg"},{"key":"2026081914163673400_qyag136-B11","doi-asserted-by":"crossref","first-page":"e65","DOI":"10.1093\/ehjci\/jead024","article-title":"Multimodality imaging in thoracic aortic diseases: a clinical consensus statement from the European Association of Cardiovascular Imaging and the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases","volume":"24","author":"Evangelista","year":"2023","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026081914163673400_qyag136-B12","doi-asserted-by":"crossref","first-page":"2225","DOI":"10.1016\/j.jcmg.2018.06.032","article-title":"Improvement in the assessment of aortic valve and aortic aneurysm repair by 3-dimensional echocardiography","volume":"12","author":"Hagendorff","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026081914163673400_qyag136-B13","doi-asserted-by":"crossref","first-page":"51","DOI":"10.3390\/jcdd8050051","article-title":"Multimodality imaging of the anatomy of the aortic root","volume":"8","author":"Paiocchi","year":"2021","journal-title":"J Cardiovasc Dev Dis"},{"key":"2026081914163673400_qyag136-B14","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.ejcts.2010.01.060","article-title":"Aortic root and cusp configuration determine aortic valve function","volume":"38","author":"Bierbach","year":"2010","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026081914163673400_qyag136-B15","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1093\/ehjci\/jeab253","article-title":"Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC Council of Valvular Heart Disease Position Paper","volume":"23","author":"Lancellotti","year":"2022","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026081914163673400_qyag136-B16","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.jtcvs.2008.08.054","article-title":"Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes","volume":"137","author":"Boodhwani","year":"2009","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026081914163673400_qyag136-B17","doi-asserted-by":"crossref","first-page":"179","DOI":"10.21037\/acs-2023-avs1-22","article-title":"Functional and pathomorphological anatomy of the aortic valve and root for aortic valve sparing surgery in tricuspid and bicuspid aortic valves","volume":"12","author":"Jahanyar","year":"2023","journal-title":"Ann Cardiothorac Surg"},{"key":"2026081914163673400_qyag136-B18","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1161\/01.RES.35.6.871","article-title":"Dimensions and geometric relationships of the human aortic valve as a function of pressure","volume":"35","author":"Swanson","year":"1974","journal-title":"Circ Res"},{"key":"2026081914163673400_qyag136-B19","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.jtcvs.2006.04.032","article-title":"A new approach to the assessment of aortic cusp geometry","volume":"132","author":"Sch\u00e4fers","year":"2006","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026081914163673400_qyag136-B20","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jtcvs.2012.06.053","article-title":"Cusp height in aortic valves","volume":"146","author":"Sch\u00e4fers","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026081914163673400_qyag136-B21","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S0022-5223(94)70465-1","article-title":"Aortic root and valve relationships impact on surgical repair","volume":"107","author":"Kunzelman","year":"1994","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026081914163673400_qyag136-B22","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1093\/ejcts\/ezz132","article-title":"Free margin length and geometric height in aortic root dilatation and leaflet prolapse: implications for aortic valve repair surgery","volume":"57","author":"Tamer","year":"2020","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026081914163673400_qyag136-B23","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jtcvs.2012.01.080","article-title":"Aortic root numeric model: annulus diameter prediction of effective height and coaptation in post-aortic valve repair","volume":"145","author":"Marom","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026081914163673400_qyag136-B24","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1016\/j.jtcvs.2013.01.030","article-title":"Numerical model of the aortic root and valve: optimization of graft size and sinotubular junction to annulus ratio","volume":"146","author":"Marom","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026081914163673400_qyag136-B25","doi-asserted-by":"crossref","first-page":"331","DOI":"10.21037\/acs.2019.05.15","article-title":"Systematic echocardiographic assessment of aortic regurgitation-what should the surgeon know for aortic valve repair?","volume":"8","author":"Berrebi","year":"2019","journal-title":"Ann Cardiothorac Surg"},{"key":"2026081914163673400_qyag136-B26","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1177\/30494826251330223","article-title":"Aortic valve repair: state of the art","volume":"2","author":"Lansac","year":"2025","journal-title":"J Heart Valve Soc"},{"key":"2026081914163673400_qyag136-B27","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1016\/j.jtcvs.2014.09.048","article-title":"Reexamining remodeling","volume":"149","author":"Sch\u00e4fers","year":"2015","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026081914163673400_qyag136-B28","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1016\/j.jtcvs.2022.02.065","article-title":"Impact of aortic valve effective height following valve-sparing root replacement on postoperative insufficiency and reoperation","volume":"164","author":"Kachroo","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026081914163673400_qyag136-B29","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.athoracsur.2003.10.103","article-title":"External aortic annuloplasty ring for valve-sparing procedures","volume":"79","author":"Lansac","year":"2005","journal-title":"Ann Thorac Surg"},{"key":"2026081914163673400_qyag136-B30","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.athoracsur.2015.07.068","article-title":"Suture annuloplasty in aortic valve repair","volume":"101","author":"Schneider","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"2026081914163673400_qyag136-B31","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/ejcts\/ezr273","article-title":"In vivo testing of an intra-annular aortic valve annuloplasty ring in a chronic calf model","volume":"42","author":"Rankin","year":"2012","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026081914163673400_qyag136-B32","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.athoracsur.2010.12.050","article-title":"New technique for aortic valve functional annulus reshaping using a handmade prosthetic ring","volume":"91","author":"Fattouch","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2026081914163673400_qyag136-B33","doi-asserted-by":"crossref","first-page":"I264","DOI":"10.1161\/CIRCULATIONAHA.106.680074","article-title":"Functional anatomy of aortic regurgitation: accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography","volume":"116","author":"Le Polain De Waroux","year":"2007","journal-title":"Circulation"},{"key":"2026081914163673400_qyag136-B34","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1093\/ejcts\/ezab039","article-title":"Summary: international consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes","volume":"60","author":"Michelena","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026081914163673400_qyag136-B35","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1161\/CIRCULATIONAHA.109.934679","article-title":"Valve configuration determines long-term results after repair of the bicuspid aortic valve","volume":"123","author":"Aicher","year":"2011","journal-title":"Circulation"},{"key":"2026081914163673400_qyag136-B36","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s11886-021-01525-z","article-title":"Which aortic valve can be surgically reconstructed?","volume":"23","author":"Abeln","year":"2021","journal-title":"Curr Cardiol Rep"},{"key":"2026081914163673400_qyag136-B37","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1111\/echo.14883","article-title":"Aortic valve area calculation using 3D transesophageal echocardiography: implications for aortic stenosis severity grading","volume":"37","author":"Beneduce","year":"2020","journal-title":"Echocardiography"},{"key":"2026081914163673400_qyag136-B38","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.echo.2017.10.003","article-title":"Feasibility, accuracy, and reproducibility of aortic annular and root sizing for transcatheter aortic valve replacement using novel automated three-dimensional echocardiographic software: comparison with multi\u2013detector row computed tomography","volume":"31","author":"Prihadi","year":"2018","journal-title":"J Am Soc Echocardiogr"},{"key":"2026081914163673400_qyag136-B39","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1093\/ehjci\/jey013","article-title":"Accuracy and reproducibility of aortic annular measurements obtained from echocardiographic 3D manual and semi-automated software analyses in patients referred for transcatheter aortic valve implantation: implication for prosthesis size selection","volume":"20","author":"Stella","year":"2019","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026081914163673400_qyag136-B40","doi-asserted-by":"crossref","first-page":"4762","DOI":"10.3390\/jcm14134762","article-title":"Three-dimensional transesophageal echocardiography is useful for preventing prosthetic-patient mismatch after surgical aortic valve replacement","volume":"14","author":"Yoshida","year":"2025","journal-title":"J Clin Med"},{"key":"2026081914163673400_qyag136-B41","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.echo.2026.01.007","article-title":"Recommendations for the identification and mitigation of cardiac ultrasound artifacts: a guideline from the American Society of Echocardiography","volume":"39","author":"Saric","year":"2026","journal-title":"J Am Soc Echocardiogr"},{"key":"2026081914163673400_qyag136-B42","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1093\/ehjci\/jes075","article-title":"Assessment of aortic valve complex by three-dimensional echocardiography: a framework for its effective application in clinical practice","volume":"13","author":"Muraru","year":"2012","journal-title":"Eur Heart J Cardiovasc Imaging"}],"container-title":["European Heart Journal - Imaging Methods and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjimp\/advance-article-pdf\/doi\/10.1093\/ehjimp\/qyag136\/70528776\/qyag136.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjimp\/article-pdf\/4\/3\/qyag136\/70528776\/qyag136.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjimp\/article-pdf\/4\/3\/qyag136\/70528776\/qyag136.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:16:50Z","timestamp":1787163410000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjimp\/article\/doi\/10.1093\/ehjimp\/qyag136\/8753934"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":42,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjimp\/qyag136","relation":{},"ISSN":["2755-9637"],"issn-type":[{"value":"2755-9637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,7,2]]},"article-number":"qyag136"}}