Intraoperative transesophageal echocardiography (TEE) assessment of the patient with aortic valve (AV) disease provides up-to-date real-time information to the surgical and anesthetic teams. The perioperative clinician may be faced with the dilemma of a patient for coronary artery bypass grafting (CABG) surgery in whom moderate aortic stenosis is discovered during intraoperative TEE. In complex aortic valve surgery, such as AV repair with or without root involvement, and whenever the ascending aorta is involved, the use of intraoperative TEE is essential. The Ross procedure involves the replacement of a diseased aortic valve, usually in the younger age group, with the patient's own pulmonary autograft. Any regurgitation of either graft indicates possible distortion during implantation and needs an immediate revision of the procedure. For echocardiography to influence the success of AV surgery it must be performed at the highest diagnostic level.