Diagnosis of Patients With VHD Undergoing Noncardiac Surgery . . . . . . . . . . . . . . . . . . . . . . e178 15.2. Management of the Symptomatic Patient . . . e179 15.3. Management of the Asymptomatic Patient . . e180 16. Evidence Gaps and Future Directions . . . . . . . . . . . . . e181 16.1. Prevention of Valve Disease: Stage A . . . . . . . e181 16.2. Medical Therapy to Treat or Prevent Disease Progression: Stage B . . . . . . . . . . . . . . . . . . . . . e182 16.3. Optimal Timing of Intervention: Stage C . . . . e182 16.4. Better Options for Intervention: Stage D e182 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e184 Appendix 1. Author Relationships With Industry and Other Entities (Relevant) . . . . . . . . . . . . . . . . . . . . . . . . . e222 Appendix 2. Reviewer Relationships With Industry and Other Entities (Comprehensive) . . . . . . . . . . . . . . . . . . . e224 TOP 10 TAKE-HOME MESSAGES 1. Disease stages in patients with valvular heart dis- ease should be classified (Stages A, B, C, and D) on the basis of symptoms, valve anatomy, the severity of valve dysfunction, and the response of the ventricle and pulmonary circulation. 2. 