To review the essential elements of the transesophageal echocardiographic examination of the aortic valve, with emphasis on the technique for performing a two-dimensional examination, the quantification of aortic stenosis and regurgitation, and the effect of this modality on cardiac surgical decision making. Literature review. Transesophageal echocardiographic examination of the aortic valve can provide detailed information on aortic valve structure and function, provided proper technique is utilized. This review presents the current recommendations from the American Society of Echocardiography for the performance of a two-dimensional examination of the aortic valve and for the quantification of aortic stenosis or aortic regurgitation by application of Doppler techniques. To demonstrate the applicability of transesophageal echocardiography in clinical practice, the effect of transesophageal echocardiography on the cardiac surgical management of patients with aortic valvular disease is described.