The expanding frontier in valve imaging.

lthough widely used for a multitude of indications, cardiovascular imaging plays a critical and irreplaceable role in the assessment of valvular heart disease. In many previous editorials, we have commented about the value of using multiple imaging modalities to gather critically important information for decisionmaking, but at the same time maintaining an awareness of the risk of duplication and waste. In this issue of iJACC, we have been fortunate to assemble a spectrum of research papers that emphasize the role of imaging in pre-operative evaluation of valvular heart disease, procedural and operative planning, and in post-operative evaluation. Clearly, much of imaging valvular heart disease focuses on valvular pathology, both anatomically and functionally. In some situations, our current algorithms for understanding the severity of valve stenosis appear to be limited. One such example of this relates to the recognition of paradoxical low-flow–low-gradient aortic stenosis (1). A potential approach, proposed by Clavel et al. (2), involves the calculation of projected aortic valve area from stress echocardiography to define the severity of aortic stenosis. However, the use of imaging should not be restricted to overt disease. The use of 3-dimensional imaging with computational simulation may provide the ability to understand leaflet stress, such an approach is not only potentially helpful in the planning of potential interventions (3) but also in the early recognition of disease. Nonetheless, the main focus of new approaches to valvular disease relate not to the valve, but to the left ventricle and aorta. Aortopathy is widely recognized as part of the bicuspid aortic valve