1. Date of download: 7/7/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACC/AHA guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on management of patients with valvular heart disease)12 J Am Coll Cardiol. 1998;32(5):1486-1582. doi:10.1016/S0735-1097(98)00454-9 Strategy for evaluating heart murmurs. ∗ If an ECG or chest x-ray has been obtained and is abnormal, an echocardiogram is recommended. Figure Legend:

2. Date of download: 7/7/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACC/AHA guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on management of patients with valvular heart disease)12 J Am Coll Cardiol. 1998;32(5):1486-1582. doi:10.1016/S0735-1097(98)00454-9 Management strategy for patients with chronic severe aortic regurgitation. Preoperative coronary angiography should be performed routinely as determined by age, symptoms, and coronary risk factors. Cardiac catheterization and angiography may also be helpful when there is discordance between clinical findings and echocardiography. In some centers, serial follow-up may be performed with RVG or MRI rather than echocardiography to assess LV volume and systolic function. Abbreviations: DD = end-diastolic dimension, RVG = radionuclide ventriculography, SD = end-systolic dimension. Figure Legend:

3. Date of download: 7/7/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACC/AHA guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on management of patients with valvular heart disease)12 J Am Coll Cardiol. 1998;32(5):1486-1582. doi:10.1016/S0735-1097(98)00454-9 Management strategy for patients with mitral stenosis. Abbreviations: CXR = chest x-ray, LA = left atrial, MVA = mitral valve area, PMBV = percutaneous mitral balloon valvotomy, PAP = pulmonary artery pressure, PAWP = pulmonary artery wedge pressure. ∗ The committee recognizes that there may be variability in the measurement of MVA and that the mean transmitral gradient, PAWP, and PAP should also be taken into consideration. †There is controversy as to whether patients with severe MS (MVA 60–80 mm Hg) should undergo MVR to prevent right ventricular failure. ††Assuming no other cause for pulmonary hypertension is present. Figure Legend:

4. Date of download: 7/7/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACC/AHA guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on management of patients with valvular heart disease)12 J Am Coll Cardiol. 1998;32(5):1486-1582. doi:10.1016/S0735-1097(98)00454-9 Management strategy for patients with mitral stenosis and mild symptoms. Abbreviations: CXR = chest x-ray, LA = left atrial, MVA = mitral valve area, PMBV = percutaneous mitral balloon valvotomy, PAP = pulmonary artery pressure, PAWP = pulmonary artery wedge pressure. ∗ The committee recognizes that there may be variability in the measurement of MVA and that the mean transmitral gradient, PAWP, and PAP should also be taken into consideration. †There is controversy as to whether patients with severe MS (MVA 60–80 mm Hg) should undergo MVR to prevent right ventricular failure. Figure Legend:

5. Date of download: 7/7/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACC/AHA guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on management of patients with valvular heart disease)12 J Am Coll Cardiol. 1998;32(5):1486-1582. doi:10.1016/S0735-1097(98)00454-9 Management strategy for patients with mitral stenosis and moderate to severe symptoms. Abbreviations: CXR = chest x-ray, LA = left atrial, MV = mitral valve, MVA = mitral valve area, PMBV = percutaneous mitral balloon valvotomy; PAP = pulmonary artery pressure; PAWP = pulmonary artery wedge pressure. ∗ The committee recognizes that there may be variability in the measurement of MVA and that the mean transmitral gradient, PAWP, and PAP should also be taken into consideration. †It is controversial as to which patients with less favorable valve morphology should undergo PMBV rather than mitral valve surgery (see text). Figure Legend:

6. Date of download: 7/7/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACC/AHA guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on management of patients with valvular heart disease)12 J Am Coll Cardiol. 1998;32(5):1486-1582. doi:10.1016/S0735-1097(98)00454-9 Management strategy for patients with chronic severe mitral regurgitation. Abbreviations: AF = atrial fibrillation, EF = ejection fraction, ESD = end-systolic diameter, FC = functional class, MV = mitral valve, NYHA = New York Heart Association, PHT = pulmonary hypertension. Figure Legend: