Abstract
Timing of valve replacement has traditionally been linked with the development of heart failure or symptoms resulting from pathophysiologic sequences resembling heart failure [1,2]. Almost 30 years after the first valve replacement, patients with aortic, mitral, or tricuspid valve stenosis receive prosthetic valves primarily to relieve symptoms associated with pulmonary and/or systemic venous congestion. Only patients with aortic stenosis have actual left ventricular dysfunction as the cause of these symptoms. Individuals with mitral and tricuspid stenosis usually develop pulmonary and systemic venous congestion, respectively, despite normal left and right ventricular function.
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