title: Valvular aspects of rheumatic heart disease.
abstract: Acute rheumatic fever and rheumatic heart disease remain major global health problems. Although strategies for primary and secondary prevention are well established, their worldwide implementation is suboptimum. In patients with advanced valvular heart disease, mechanical approaches (both percutaneous and surgical) are well described and can, for selected patients, greatly improve outcomes; however, access to centres with experienced staff is very restricted in regions that have the highest prevalence of disease. Development of diagnostic strategies that can be locally and regionally provided and improve access to expert centres for more advanced disease are urgent and, as yet, unmet clinical needs. We outline current management strategies for valvular rheumatic heart disease on the basis of either strong evidence or expert consensus, and highlight areas needing future research and development.
authors.affiliation: Menzies School of Health Research, Darwin, NT, Australia.
authors.forename: Boglarka
authors.initials: B
authors.lastname: Remenyi
authors.affiliation: Department of Cardiology, Aswan Heart Centre, Aswan, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: ElGuindy
authors.affiliation: Heart and Vascular Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.affiliation: Cardiothoracic Surgery, Imperial College London, London, UK.
authors.forename: Magdi
authors.initials: M
authors.lastname: Yacoub
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, MN, USA. Electronic address: holmes.david@mayo.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D012214:Rheumatic Heart Disease / Q000150:complications*