Key Points
Î Patients with VHD may present with a heart murmur, symptoms, or
incidental findings of valvular abnormalities on noninvasive testing.
Î The initial evaluation should include a detailed history and physical
exam, ECG, chest x-ray, and transthoracic echocardiogram.
Î Decisions about treatment are based primarily on the presence or
absence of symptoms, severity of VHD, and response of the ventricle
to pressure or volume overload imposed by VHD.
Î VHD requires a multidisciplinary team and approach for its diagnosis
and management.
Î Reasons for valve intervention are to improve symptoms, prolong
survival, and reduce the risk of complications.
Î An evaluation of the surgical or interventional risk for each individual
patient should be performed if intervention is indicated which
includes a standard surgical risk score, along with consideration of
comorbidites, frailty, and procedure specfic impediments.
Î Follow-up of patients with VHD is important to assess symptom
status, provide patient education, and monitor disease severity,
typically with periodic echocardiography.
Table 1. The Heart Valve Team
Recommendations COR LOE
Patients with severe VHD should be evaluated by a
multidisciplinary Heart Valve Team when intervention
is considered.
I C
Consultation with or referral to a Heart Valve Center of
Excellence is reasonable when discussing treatment options for
• asymptomatic patients with severe VHD,
• patients who may benefit from valve repair versus valve
replacement, or
• patients with multiple comorbidities for whom valve
intervention is considered.
IIa C
2
The Heart Valve Team
