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In the last decade three dimensional echocardio-graphy (3DE) technology has evolved significantly, and the advance of matrix transducers has made its use commonplace in daily clinical practice.1 Currently, it is possible to acquire real-time 3DE images for appropriate visualisation of valvular anatomy and proper quantification of valvular heart disease (VHD). However, 3DE quality depends of a number of factors, including the intrinsic quality of the ultrasound images, the number of heart beats used to reconstruct each 3DE image, and the ability to limit motion artefacts with adequate electrocardiographic and respiratory gating.2 The latter is particularly challenging when using systems requiring electrocardiographicall