Comprehensive 3D echocardiography assessment of mitro-aortic valvular physiology. Are we ready?

Non-invasive mitral and aortic valve evaluation is important in clinical cardiology. Acquired pathology contributes to high morbidity and mortality. Technical developments, both in surgery and in interventional cardiology, have contributed to the increase in the type and number of treatment procedures. Older patients, sicker patients, and more complex abnormalities are now available for treatment. In this context, non-invasive imaging plays a crucial role not only in valvular heart disease diagnosis but also, and more important, in the selection of best therapeutic approach for each patient. Aortic and mitral valve are anchored to the fibrous skeleton of the heart. They are in close proximity through the mitro-aortic continuity and share the left and right fibrous trigones. They both are conformed by the annulus, leaflets, and tendineous cords (mitral valve). The left ventricle (LV) plays a key role in the physiology of both valves that far from being passive elements have their own intrinsic function. Both the mitral annulus (MA) and the aortic annulus (AA) with a pre-determined shape undergo anatomical changes along the cardiac cycle that contributes to the function of the valve itself.