Echocardiography is central in bicuspid aortic valve (BAV) syndrome. In the vast majority of BAV patients, echocardiography is key in diagnosing the disease, to assess presence and severity of associated hemodynamic valvular abnormalities, to detect and quantify BAV-related aortopathy and in screening family members. Moreover, it can also be used to diagnose potentially associated congenital heart disease. Strict observance of appropriate methodology, including knowledge of classification and nomenclature, is necessary to appropriately report the echocardiographic findings and to communicate with patients and other health care providers. As ultrasound is the tool of choice for long-term surveillance of BAVs, methodological care and consistency are needed to optimize accuracy and minimize inappropriate referral patterns. The assessment of hemodynamic valvular impairment must proceed through a multi parametric approach, comprehensively evaluating also the consequence on left ventricular remodeling and function. The quality of echocardiographic measurement of the aortic dimensions is excellent, if accurately performed and interpreted, limiting the resort to multimodality to specific situation. Echocardiography, thus, plays a pivotal role in clinical practice, but it will keep on playing this role also in the modern, translational approach in studying BAV.