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Mixed Aortic Valve Disease: A Diagnostic Challenge, a Prognostic Threat

ABSTRACT Mixed aortic valve disease, defined as the combination of aortic stenosis and regurgitation, is a frequent condition for which a poor prognosis has recently been demonstrated, likely as a result of its specific pathophysiology. Echocardiography, based on consecutive evaluation of stenosis, regurgitation, and global effects caused by the valve disease, is the diagnostic cornerstone of severity assessment, but advances in imaging, including speckle-tracking echocardiography, multidetector computed tomography, and cardiac magnetic resonance, may improve the diagnostic yield. Current surgical or transcatheter management is mainly based on criteria used for isolated stenosis or regurgitation, including symptoms and left ventricular dilatation and/or dysfunction, but emerging evidence tends to support earlier management. Ideally, a randomized trial in asymptomatic patients with preserved ejection fraction would be needed to evaluate the potential benefit of this approach.