Chronic valvular heart diseases are slowly progressive conditions in which the physician’s role is to make a correct diagnosis, prevent and treat possible complications, and to evaluate accurately the severity and degree of haemodynamic impairment for an adequate timing of surgical treatment. In the last decade, the advances in valve replacement and the more accurate indications for surgical therapy have resulted in improved immediate and long-term post-operative outcome. Usually, surgical treatment is indicated if the patient has cardiac symptoms. However, some asymptomatic patients with severe valve regurgitation benefit from early valve replacement before the development of symptoms: valve regurgitation results in volume overload, which may irreversibly reduce left ventricular function, occasionally before the development of symptoms.