title: Update on rheumatic heart disease.
abstract: OBJECTIVE
  The purpose is to provide a broad overview of the current state of knowledge of pathogenesis, diagnosis, and management of rheumatic heart disease (RHD).
  
  
  RESULTS
  Studies on pathogenesis of RHD have focused on autoimmunity because of molecular mimicry between the streptococcal M antigen α-helical coiled-coil structure and sarcomeric proteins such as myosin and tropomyosin. More recently, nonsarcomeric autoantigens, endothelial injury and the innate immune system have been proposed to play key roles in the pathogenesis of RHD. In the 2015 revised Jones Criteria, the importance of echocardiography and subclinical carditis in the diagnosis of acute rheumatic fever is highlighted. Experimental studies with targeted anti-inflammatory therapeutics have been largely unsuccessful and the only established treatment is still lifelong antibiotics. Efforts to improve patient selection and outcomes with percutaneous mitral balloon valvuloplasty are ongoing. With regard to surgical management, several groups have demonstrated excellent operative and midterm outcomes from valve repair as opposed to valve replacement.
  
  
  CONCLUSIONS
  There are still many unanswered questions regarding RHD pathogenesis. The only accepted medical treatment is still long-term antibiotic therapy, whereas advances in mitral repair techniques have led to successful durable repairs being performed in high-volume, expert centers.
authors.affiliation: aDivision of Cardiac Surgery, St Michael's Hospital bDivision of Pathology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Bobby
authors.initials: B
authors.lastname: Yanagawa
authors.forename: Jagdish
authors.initials: J
authors.lastname: Butany
authors.forename: Subodh
authors.initials: S
authors.lastname: Verma
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D019468:Disease Management; D004452:Echocardiography / Q000379:methods; D006801:Humans; D007109:Immunity; D018716:Molecular Mimicry / Q000502:physiology; D017063:Outcome Assessment, Health Care; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents