With advances in the field of cardiovascular surgery, aortic valve-sparing surgery including aortic valvuloplasty and aortic root reconstruction or remodeling has become a therapeutic option for young patients with aortic regurgitation (AR). As a result, progress has been made in terms of anatomical understanding and evaluation of the aortic valve complex, such as aortic root and valve structure. Because aortic valve-sparing surgery is a more complicated procedure than surgical aortic valve replacement, it is necessary to understand in detail not only the anatomy of the aortic valve complex but also the AR mechanism and pathological changes associated with AR. Echocardiography is very useful for assessing the AR severity, anatomy and underlying mechanism for evaluation of the feasibility of aortic valve-sparing surgery and prediction of the long-term postoperative outcome. In this report, we summarize the preoperative evaluation of echocardiography for aortic valve-sparing surgery.