RT Journal Article SR Electronic T1 The challenge of valvular heart disease: When is it time to operate? JF Cleveland Clinic Journal of Medicine JO Cleve Clin J Med FD Cleveland Clinic SP 463 OP 482 VO 71 IS 6 A1 Reginelli, Joel P. A1 Griffin, Brian YR 2004 UL http://www.ccjm.org/content/71/6/463.abstract AB In patients with valve disease, operating too soon exposes them to unnecessary surgical risk, but waiting too long may lead to cardiac damage and poor outcome. When to refer a patient for surgery depends on which valve is involved, the type of defect (stenosis or regurgitation), the degree of the defect, and the degree of symptoms or functional impairment.