[Management of patients with valvular disease]

The strategy for the management of valvular disease, in the diagnostic but especially in the therapeutic stage, remains complex in patients who are often elderly and suffering from multiple illnesses. A physical examination is essential, and represents the first stage in evaluating the severity of valvular disease. In asymptomatic patients, it is advisable to use stress tests where there is doubt over the patient's functional capacity. Echocardiography has replaced catheterization in evaluating the severity of valvular disease. The results of non-invasive examinations should be critically reviewed, with the aim of reconciling the estimation of the severity of the disease with its symptoms and consequences. The evaluation of comorbidities is an essential step in risk analysis. Therapeutic choices must take into account the natural history and the risks and benefits of intervention. The therapeutic decision, especially in the case of intervention, must be made on an individual basis taking on consideration of both medical and surgical factors.