Abstract
Management of aortic valve and aortic root disease has evolved alongside an expanding therapeutic landscape that includes valve repair, valve-sparing root replacement, composite graft reconstruction, transcatheter therapies, and autograft-based approaches. Because these strategies differ in durability, hemodynamic performance, and implications for future reintervention, procedural selection must be individualized. Multimodality imaging is central to this process, integrating valve phenotype, annulus-root geometry, ventricular remodeling, and clinical context to refine procedural planning. As surgical and transcatheter options continue to expand, imaging remains fundamental to durable, patient-centered management of aortic valve and root disease.