Chronic aortic and mitral regurgitation. Choosing the optimal time for surgical correction.

Valvular surgery for chronic aortic and mitral regurgitation is indicated when symptoms of congestive heart failure have advanced to New York Heart Association class III or when definite and reproducible evidence of left ventricular systolic dysfunction has developed, even in the absence of severe or limiting symptoms. The presence of left ventricular systolic dysfunction can be detected using both invasive and noninvasive measurements of left ventricular end systolic volume (or dimension), end systolic wall stress, and ejection fraction (or fractional shortening). Post-operative results can be optimized when corrective surgery is performed before or soon after the development of left ventricular systolic dysfunction or the development of advanced symptoms.