Cardiac-related perioperative complications are well-known in general practice. The role of echocardiography in preoperative risk assessment before non-cardiac surgery remains unclear though. In this article we discuss recently published guidelines, articles and opinions in the domain of preoperative risk assessment of patients with valvular heart disease undergoing non-cardiac surgery. We created a risk stratification model that can be used in daily practice. This model may increase our awareness of the risks associated with heart valve disease in the perioperative period.