Valvular heart disease in adults. When to call in the surgeon.

Valvular heart disease is now amenable to surgical intervention. Valve surgery needs to be considered at the appropriate time so that patients are not denied the benefit of operation. Patients with indications for surgery should be operated on before progressive left ventricular dysfunction or the complications attendant to valvular heart disease develop. Delay of indicated surgery may increase the operative risk. This does not mean that patients should be referred for surgery before the appropriate indications appear. It does mean, however, that patients with valvular heart disease should be followed for evidence of progressive signs and symptoms attendant to the disease. Clinical and laboratory evidence of valvular and/or ventricular dysfunction determines when surgical intervention is necessary. Once indications for valve surgery appear, prompt referral is indicated.