[Criteria for the optimal time of heart valve surgery]

The timing for heart surgery in mitral and aortic stenosis is still determined by the clinical situation such as NYHA-classification III and IV (or II in exceptional cases). In symptomatic patients with aortic incompetence surgery should be performed quickly. Patients with slight symptoms should only be operated if there are sings of left ventricular insufficiency at rest. There is still a discussion about patients with signs of left ventricular dysfunction on exercise; in such patients controls at short intervals are recommended. As long as left ventricular function is normal patients with aortic incompetence have a good prognosis. In patients with mitral incompetence the same criteria can be used but there are no sufficient studies on patients with normal left ventricular function which were operated. Non-invasive diagnostic techniques seem to be sufficient for the follow-up-examinations.