(p. 737) Causes and diagnosis of valvular problems 

While valvular heart disease encountered in developing countries is primarily rheumatic in aetiology, in industrialized countries it is largely comprised of degenerative valvular disease. Although less prevalent than ischaemic heart disease, its prevalence increases with older age and increased life expectancy, and therefore represents significant disease burden in aging populations. Transthoracic echocardiography remains the imaging modality of choice for timely delineation of the anatomy and severity of the lesion,although, once identified, may not correlate with symptoms due to clinical latency of disease onset to disease manifestation. Variations of disease severity, which may not meet criteria for intervention, lead to chronicity of disease, while clinically silent lesions may remain undiagnosed—both of these situations may lead to acute illness requiring intensive care management. Stabilization through medical intervention may be required, although many patients with severe disease will need emergent surgical repair, therefore collaborative involvement between intensivists, cardiologists, and cardiovascular surgeons is needed to minimize patient mortality and morbidity.