{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:06:01Z","timestamp":1787655961592,"version":"build-2736575974"},"reference-count":87,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,6,17]],"date-time":"2023-06-17T00:00:00Z","timestamp":1686960000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Aortic stenosis (AS) can often coexist with other valvular diseases or be combined with aortic regurgitation (AR), leading to unique pathophysiological conditions. The combination of affected valves can vary widely, resulting in a lack of standardized diagnostic or therapeutic approaches. Echocardiography is crucial in assessing patients with valvular heart disease (VHD), but careful consideration of the hemodynamic interactions between combined valvular defects is necessary. This is important as it may affect the reliability of commonly used echocardiographic parameters, making the diagnosis challenging. Therefore, a multimodality imaging approach, including computed tomography or cardiac magnetic resonance, is often not just beneficial but crucial. It represents the future of diagnostics in this intricate field due to its unprecedented capacity to quantify and comprehend valvular pathology. The absence of definitive data and guidelines for the therapeutic management of AS in the context of multiple valve lesions makes this condition particularly challenging. As a result, an individualized, case-by-case approach is necessary, guided primarily by the recommendations for the predominant valve lesion. This review aims to summarize the pathophysiology of AS in the context of multiple and mixed valve disease, with a focus on the hemodynamic implications, diagnostic challenges, and therapeutic options.<\/jats:p>","DOI":"10.3390\/diagnostics13122102","type":"journal-article","created":{"date-parts":[[2023,6,19]],"date-time":"2023-06-19T01:59:51Z","timestamp":1687139991000},"page":"2102","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Beyond Aortic Stenosis: Addressing the Challenges of Multivalvular Disease Assessment"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7716-9635","authenticated-orcid":false,"given":"Sara","family":"Bombace","sequence":"first","affiliation":[{"name":"Leipzig Heart Science, 04289 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Chiara","family":"Meucci","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Fortuni","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands"},{"name":"Department of Cardiology, San Giovanni Battista Hospital, 06034 Foligno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3885-5093","authenticated-orcid":false,"given":"Federica","family":"Ilardi","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2954-4402","authenticated-orcid":false,"given":"Rachele","family":"Manzo","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grazia","family":"Canciello","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Grayburn","sequence":"additional","affiliation":[{"name":"Baylor Scott & White Research Institute, Plano, TX 75093, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Angela","family":"Losi","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Sannino","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy"},{"name":"Baylor Scott & White Research Institute, Plano, TX 75093, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1161\/CIRCIMAGING.118.007862","article-title":"Multiple and Mixed Valvular Heart Diseases","volume":"11","author":"Unger","year":"2018","journal-title":"Circ. 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