In developed countries, degenerative valve disease, which has similar risk factors to coronary heart disease, is becoming more common as life expectancy increases. Open-access or surgery-based electrocardiography and echocardiography enable general practitioners, in consultation with cardiologists, to diagnose and manage valve disease. Management of low-risk valve conditions in primary care, with primary-care-based echocardiography, reduces the need for hospital follow-up. Patients with complex valve disease, who have cardiac impairment, arrhythmia or endocarditis, are usually under review by a cardiologist. Three-dimensional echocardiography is not used in routine clinical practice, but may be useful for providing information about valve structure. Modern echocardiography and Doppler examination have reduced the need for invasive pressure measurements, particularly in mitral valve disease in young people. Patients with mild valve conditions and those in whom the risks of surgery are unacceptably high may be treated medically and monitored in primary care. Thromboembolism and anticoagulant-related bleeding account for nearly all the problems after valve replacement.