Chronic aortic valve disease is often tolerated for a long period of time with little in the way of symptoms, but once symptoms develop, the downhill course is often rapid. Medical therapy may alleviate symptoms of congestive heart failure and angina, but does not alter the natural history of the disease. The recent advances of cardiac surgery have, however, considerably improved the prognosis of most patients. Some patients with aortic regurgitation, though, will develop progressive congestive heart failure despite aortic valve replacement. Others with severe aortic stenosis will die suddenly while awaiting surgery as will a small number who previously had been asymptomatic. The information that comes from cardiac catheterization as well as the non-invasive investigation of cardiological disease, greatly enhanced by the introduction of the echocardiogram, has provided the physician with a better understanding of the particular problems in question and, therefore, the potential to solve them. This article aims to review the means by which high-risk groups can be identified, in order that their outlook may be improved especially with respect to the timing of surgical intervention.
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