Recommendations on the management of the asymptomatic patient with valvular heart disease

The management of asymptomatic patients with valve disease has become an important medical problem. There are two main reasons for this: firstly such patients are currently being diagnosed more frequently because of the widespread availability of echocardiography; secondly, the opportunity to perform less invasive interventions is an incentive to intervene earlier. However, data concerning the management of asymptomatic patients are limited. For this reason this topic remains a particularly rich source of debate. There are no specific guidelines on the management of asymptomatic patients with valvular heart disease and recommendations can be drawn only from general guidelines such as those produced by the ACC/AHA and some national societies in Europe. Moreover, published guidelines are not always consistent due to the lack of randomized trials and also the constant evolution of practice. It is for this reason that the Working Group on Valvular Heart Disease of the European Society of Cardiology have produced these recommendations. The major types of acquired valve disease will be dealt with in the following order: aortic stenosis (AS), aortic regurgitation (AR), mitral stenosis (MS), mitral regurgitation (MR).