Aortic regurgitation (AR) causes chronic volume overload, which leads to progressive myocardial damage. Surgery is indicated in patients with severe AR and symptoms. In recent years, outcomes for aortic valve sparing or aortic valve plasty have improved, and more and more institutions in Japan are actively selecting these procedures. Assessment of the aortic valve and aortic valve complex using transthoracic and transesophageal echocardiography before performing these procedures is an essential part of the therapeutic strategy. Not only cardiac cavity size and cardiac function but also the properties of the aortic valve such as prolapse, perforation, calcification, and degeneration can be observed using echocardiography. These findings are used for the procedure-conscious classification of AR. Detailed observation of the aortic valve complex using echocardiography leads to a better understanding of the pathogenesis and anatomical characteristics of AR, and can be very useful for aortic valve plasty. Doctors and sonographers who work in clinical echocardiography may need to make an effort to understand the surgical procedures and provide surgeons with useful echocardiographic information.