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[How it changed the clinical indications and surgical treatment of valvular heart diseases. The clinical challenge].

In the last 30 years, it has changed the prevalence an etiology of valvular heart diseases. They have diminished the rheumatic valvular diseases and have increased the degenerative etiology in elderly people. Globally they continue to be a major pathology in the Departments of Cardiology. The diagnosis has changed and echocardiography/doppler has turned into the basic test for the diagnosis and follow-up of these patients. This best knowledge of the evolution of the different pathologies has allowed the understanding of the more precise timing for surgical treatment, without awaiting the appearance of advanced symptomatology. The percutaneous technologies for the treatment are appearing as an alternative to the cardiac surgery for the patients with high rates of comorbidity and mortality.