Diagnostic Testing: Routine Follow-Up After initial evaluation of an asymptomatic patient with VHD, the clinician should continue regular follow-up with periodic examinations and TTE. The purpose of follow- up is to prevent the irreversible consequences of severe VHD, primarily affecting the status of the ventricles and pulmonary circulation, which may occur in the absence of symptoms. At a minimum, a yearly history and physical examination are necessary. The frequency of repeat 2D and Doppler echocardiography is based on the type and severity of the valve lesion, the known rate of progression of the specific valve lesion, and the effect of the valve le- sion on the affected ventricle (Table 5).1 14 Patients with Stages C2 and D disease are not included in this table because they would be considered candidates for inter- vention. The follow-up interval may be extended in pa- tients with mild regurgitation who show no change over a 10- to 15-year period. In addition to routine periodic imaging, the onset of symptoms or a change in the physi- cal examination should raise concern about the cardiac response to the valve lesion, necessitating a repeat TTE. 2.3.4. Diagnostic Testing: Cardiac Catheterization Although TTE is now able to provide the required anatomic and hemodynamic information in most Table 3. 