Heart valve operation is assessed with patient-specific medical diagnostic imaging data. To deal with the complex motion of the passive valve tissue, a hierarchal model is used. Rigid global motion of the overall valve, non-rigid local motion of landmarks of the valve, and surface motion of the valve are modeled sequentially. For the non-rigid local motion, a spectral trajectory approach is used in the model to determine location and motion of the landmarks more efficiently than detection and tracking. Given efficiencies in processing, more than one valve may be modeled at a same time. A graphic overlay representing the valve in four dimensions and/or quantities may be provided during an imaging session. One or more of these features may be used in combination or independently.