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The average age of patients in Germany reporting first ever symptoms due to valvular heart disease(VHD)was(49±9)years in 1965,(63±11)years in1985,and(76+13)years in 2005.The increasing age went parallel with the change in etiology of VHD,with rheumatic mitral stenosis prevailing in 1965 and degenerative aortic stenosis(AS)in 2005.