Diagnosis, Indication and Timing

In this first chapter, the role taken by the different imaging modalities for the diagnosis and timing of the aortic valvular diseases will be described. The key function of multimodality imaging (transthoracic and transesophageal echocardiography, computed cardiac tomography, cardiac magnetic resonance imaging, nuclear radiology and angiography) will be illustrated in the context of aortic stenosis pathology, low-flow low-gradient aortic stenosis and aortic valve insufficiency. This will include which imaging techniques to adopt for the best stratification and quantification of valve diseases, according to international guidelines. In the section covering anatomical assessment, the various aortic valve morphologies are discussed, in particular the comparison between bicuspid and tricuspid ones. Anatomical criteria for understanding surgical reparability and the analysis of valve calcifications will also be discussed. In concluding, the timing and functional evaluation of the pathology, the role and imaging techniques in the evaluation of biventricular contractility and relative contractile reserve in case of low-flow low-gradient are discussed.