Professor Alfieri, you are a world-renowned cardiac surgeon. You pioneered several methods of heart surgery. And you have treated tens of thousands of patients with heart valve disease and with other heart disease of every degree of difficulty. How a patient with heart disease should think about choosing the best treatment? Especially, of course, for patients in your specialty in cardiac heart valve disease.

First of all, you have to be aware that very often, heart valve disease doesn't produce immediately important symptoms. So, you have to be really as a patient rather careful and to try to detect something different from what was the condition before. So, you may feel, for instance, some arrhythmias, some dyspnea. And if you are short of breath, if you have some of these symptoms, you have to try to evaluate your situation. And this can be very easily done in any place. You can get have an echocardiogram showing how the heart valves are functioning. If a heart valve disease and important heart valve disease is found, then I think it is very important to try to be treated in heart valve centers where you can find all the experience and the expertise to offer you the best treatment for your situation. The important thing is to be aware that heart valve disease can be treated differently. Heart valve disease treatment can be more invasive, or it can be minimally invasive. Treatment can be done even with the catheters. Obviously, we are all attracted by the fact that transcatheter heart disease treatment doesn't require anesthesia. It does not require an incision. It does not require extracorporeal circulation or thoracotomy. Nothing! So everybody is very much attracted by that. But we have to take into consideration also the result of the treatment. And if you're a young patient, of course, you have really to consider that for you the most important thing is to have a treatment which can be effective for your entire life. You have to solve your problem definitively. So I think these are the considerations that you need to have to be treated properly. You have to be in contact all the time with your doctors and to be aware of all therapeutic options which are available today. And you must have confidence in your doctors, particularly in the doctor's ability to have the availability of all the therapeutic options. Because if your doctor has only one way to treat the heart valve disease, then you're going to have that treatment. You are not offered what may be the best treatment. So it's very important to choose a center of excellence where you can have all the procedures available. In such a way, you can be sure that doctors will offer you the best treatment for your individual need.

So what I hear is it's important for patients - as soon as they notice that something is not as perfect as it might have been in the past - to be proactive in doing appropriate diagnostic testing. You mentioned echocardiography.

Echocardiography is probably the easiest diagnostic test. If echocardiography is showing an important heart valve disease, then you have to think about the treatment. And the treatment should be carried out in centers that have experience and expertise.

Also, you mentioned that it's important to be proactive. A patient should not ignore the symptoms and sometimes follow just a conservative therapy path. Because doing the surgery early, at the appropriate time, is key to recovery.

Yes, because this is very typical for some heart valve diseases. For instance, mitral regurgitation, tricuspid valve regurgitation, aortic valve insufficiency, and many valve diseases - they are all asymptomatic for a long time. Unfortunately, when the patient becomes symptomatic, it is often too late because we already have some degree of left ventricular dysfunction, right ventricular dysfunction, pulmonary hypertension. And your life, even after treatment, is not going to be as normal as the one in a general population.

So addressing the structural heart valve disease early leads to the best result.

Exactly! Early treatment leads to a quality of life that is a similar to a normal population. But the secret is early treatment!