Valvular heart disease. Identifying and managing mitral and aortic lesions.

Evaluation and treatment of valvular heart disease (table 1) are in evolution. Echocardiography is the principal diagnostic tool. In general, mitral and aortic stenotic lesions warrant surgical treatment when symptoms appear. Such intervention is also indicated in symptomatic patients with a regurgitant mitral or aortic lesion. Some patients with regurgitant lesions require surgical treatment even before the onset of symptoms, such as when left ventricular dysfunction or dilatation supervenes. Surgical treatment of valvular lesions consists of repair or replacement, except in the case of mitral stenosis, where PBMC is a reasonable alternative. In general, medical therapy has a very limited role in the treatment of valvular heart disease. Severe aortic insufficiency is an exception. In such cases, afterload reduction has proved beneficial in the long-term prognosis.