Valvular surgery is indicated, as our patient is symptomatic and the lesion is severe. The treatment of choice is valve repair if at all possible. If not, valve replacement should be carried out. Factors that reduce the risk of surgery include our patient’s age, adequately preserved left ventricular function, and the absence of additional pathology.

Additionally, at the time of surgery, the left atrial appendage is often removed to reduce future thromboembolic events. Surgical ablation of the patient’s atrial fibrillation is another consideration.

Prosthetic valve replacement must be undertaken with the full recognition of the natural history and the complications that may occur after the procedure. In effect, one may be changing one disease for another. Problems such as valve dysfunction, deterioration, perivalvular leak, infective endocarditis, thromboembolism, and bleeding from any necessary anticoagulation therapy must be considered.