The public health burden of valvular heart disease (VHD) is projected to grow over the ensuing years owing to the persistent spectre of rheumatic heart disease in developing countries,^w1 and the increasing rate of degenerative VHD among the ageing population in developed countries.1 Morbidity and mortality associated with these conditions and their treatment are high.^w2 Thus optimal evaluation of VHD is of clear importance.

There are many approaches to the assessment of VHD.2 The aim of this article is first to provide a brief overview of the pathophysiology of the four most common valvular lesions: mitral regurgitation, mitral stenosis, aortic stenosis, and aortic regurgitation. The evolving role of cardiac imaging in the evaluation of these conditions will then be examined. The focus of this article is on multimodality imaging, and the complementary information these techniques provide on the most common valvular lesions (table 1). These imaging techniques are of increasing relevance given the invasive nature of cardiac catheterisation in the quantification of left ventricular (LV) function and VHD severity. The role of imaging in valvular intervention and in the assessment of the prosthetic valves (recently reviewed in Heart^{w3 w4}) lies outside the scope of the present article.

Mitral regurgitation

The mitral valve (MV) apparatus is a complex structure. It comprises a fibrous annulus, whose saddle-like geometry has proven challenging to represent using older, two dimensional (2D) imaging approaches. Three dimensional (3D) imaging modalities, especially 3D echocardiography and multidetector row CT (MDCT), have allowed better characterisation of the mitral annulus, its dynamic nature, and the changes associated with mitral regurgitation (MR) (figure 1).^{w5 w6}