ABSTRACT
Over the past 25 years there have been marked changes in the demographics, clinical presentation, etiology, and treatment of acquired valvular heart diseases.1 In western countries, with the decline of rheumatic fever and with the aging population, degenerative valve disease has become the main etiology. However, this shift in etiology is limited to industrialized countries, as rheumatic heart disease remains the most frequent etiology of valvular heart disease in developing countries.
