Changing concepts in the diagnosis and management of patients with valvular heart disease: a clinician's view.

The epidemiology, natural history, diagnostic evaluation and therapy of patients with valvular heart disease have changed during the last 25 years in developed countries. The incidence of rheumatic heart disease has declined, while degenerative forms of valvular heart disease have become more common; arteriosclerotic heart disease commonly complicates valvular disease. A variety of non-invasive techniques demonstrate with considerable accuracy the presence and severity of valvular lesions. Both medical and surgical therapy for valvular heart disease have improved; the prognosis for these patients is far better today than it was 25 years ago.