Clinical approach and management of acquired valvular heart disease

Before discussing the various acquired valvular lesions, we emphasize three important points: we firmly believe that the diagnosis, location, and quantitation of the various valvular lesions can usually be made in the office or at the bedside by a careful clinical examination; electrocardiography, roentgenography, and echocardiography allow the clinician to document his clinical evaluation; hemodynamic evaluation or confirmation is necessary in selected patients only. For these reasons this chapter focuses on the clinical differential diagnosis of the various valvular entities. The ideal time for operation of valvular heart disease depends on the performance record of that type of operation in relation to the anticipated outlook of the patient without operation. Therefore, various aspects and risks of the different surgical procedures are discussed.