Heart defects are a complex group of diseases that require an individual approach to diagnosis and treatment. This article focuses on developing a personalized management strategy for patients with congenital and acquired heart defects, analyzing the advantages of cardiological follow-up compared to surgical intervention. Modern diagnostic methods, including echocardiography, computed tomography and magnetic resonance angiography, make it possible to assess the severity of the defect, the functional state of the heart and predict the clinical outcome. Based on these data, a decision is made on the need for conservative treatment or surgery. The work emphasizes the importance of taking into account many factors, such as the patient's age, the degree of damage to the valve apparatus, the presence of concomitant pathology and general health. In some cases, cardiological monitoring may be preferable to control symptoms and monitor the progression of the disease, especially in patients with low surgical tolerance. However, if serious complications develop, such as decompensated heart failure or thromboembolic complications, surgical intervention becomes an urgent solution. Special attention is paid to modern minimally invasive technologies, such as transcathetic implantation of prosthetic valves and robotic surgical systems, which significantly reduce the risk of complications and accelerate the recovery of patients. The authors also discuss the role of genetic tests and biomarkers in determining the most effective type of therapy for a particular patient. The authors emphasize the need for a multidisciplinary approach, including the work of cardiologists, surgeons, anesthesiologists, and rehabilitologists, to create an optimal treatment strategy for each patient.