Left ventricular function and the timing of surgical treatment in valvular heart disease.

The problem of when to recommend surgical treatment for valvular heart disease to avoid irreversible left ventricular damage has not been fully resolved. In aortic stenosis, left ventricular function tends to improve after aortic valve replacement even if it is markedly depressed, and operation solely to prevent irreversible left ventricular dysfunction does not seem indicated. In aortic regurgitation, left ventricular function also usually improves postoperatively if moderately depressed, but in an adult with relatively few symptoms operation should be considered when there is progressive or marked cardiomegaly with reduced systolic function. In chronic mitral regurgitation, limited studies indicate that if left ventricular size is markedly increased and the ejection fraction is even mildly reduced, left ventricular function deteriorates postoperatively; in such patients consideration of operation may be warranted even if symptoms are few. It is concluded that operative mortality and morbidity are now sufficiently low that valve replacement or repair can be considered primarily to preserve left ventricular function under certain circumstances.