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 AS 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 AS,
• patients who may benefit from valve repair versus valve
replacement, or
• patients with multiple comorbidities for whom valve
intervention is considered.
IIa C
The Heart Valve Team
