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Valvular disease in the perioperative period

Valvular disease: Among the valvular affections the most dangerous one is aortic stenosis, unfortunately, this kind of disease is the commonest one in current surgery population. In case of severe aortic stenosis (valvular area \1 cm or 0.6 cm2/m2 BSA) clinical condition of patient should be evaluated: symptomatic patients undergoing elective surgery should be offered chance of prophylactic aortic valve replacement prior to non-cardiac surgery. Patients who refuse or are not eligible should be considered for a percutaneous valve implantation or at least balloon aortic valvuloplasty. This strategy should be considered even in case of asymptomatic patients scheduled for high-risk surgery. Asymptomatic patients scheduled for intermediate or low-risk surgery can be treated in a conservative manner. High-risk surgery can be performed only in patients not eligible for aortic replacement only if really needed and under strict hemodynamic monitoring.

Mitral stenosis: This kind of disease does not preclude surgery especially low and intermediate risk ones. Symptomatic patients with significant mitral stenosis (area \1.5 cm2) associated with pulmonary hypertension (i.e., PAP [ 50 mm Hg) should be considered for preventive percutaneous mitral commissurotomy or open surgical valve repair especially if scheduled for high-risk surgical procedures.

Aortic and mitral regurgitation: This kind of affection usually does not affect perioperative course unless there is concomitant presence of poor left ventricular function (i.e., EF\30%) those patients should be strictly hemodynamically monitored and pharmacological therapy should be optimized carefully before surgical procedure. High-risk surgery procedures should be considered only if necessary. 

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