Current surgical treatment of valvular heart disease.

Surgery for valvular heart disease has undergone important refinements during the past several years. The general indications for valvular surgery are the presence of symptoms that interfere with the patient's lifestyle and that cannot be controlled with medical therapy, and indications of a threat to continued survival, such as angina, dyspnea, effort syncope or progressive impairment of ventricular contractility. Infective endocarditis may also be an indication for valvular surgery in patients with congestive heart failure, recurrent embolism, persistent infection despite antibiotic therapy, large vegetations or progressive conduction defects. Surgical procedures for the treatment of valvular heart disease include reconstruction techniques and valve replacement procedures. Reconstructive surgery minimizes the amount of materials that must be implanted. Advances in myocardial preservation have reduced the risk of such complex cardiac surgical procedures as multiple valve replacements and valve replacements combined with coronary artery bypass surgery. Follow-up care is important to monitor valve function, fluid balance and anticoagulation.