Calcific aortic stenosis is a disease of the elderly and aortic valve replacement should always be considered for severe symptomatic disease; comorbidities, not age, determine surgical risk. Aortic regurgitation imposes a pressure and volume load on the left ventricle so that close monitoring is needed to identify patients at risk for irreversible left ventricular dysfunction, although symptoms are the most common indication for valve replacement. Early intervention now is recommended for rheumatic mitral stenosis due to the effectiveness of percutaneous balloon valvotomy. Earlier intervention also may be considered in selected patients with mitral regurgitation at experienced centers when valve anatomy is favorable for a successful repair. Semiquantitative descriptors of regurgitation as mild, moderate, or severe are no longer adequate; management of adults with chronic valve disease requires quantitation of both the severity of valve disease and of left ventricular size and systolic function.