Doppler echocardiographic assessment of subclinical valvitis in the diagnosis of acute rheumatic fever.

almost 200 years after the initial descriptions of the cardiac involvement by Wells in 1812, and by Jean-Baptiste Bouillaud in 1836, rheumatic fever remains a significant challenge to those involved in providing health care.1 Although impressive data have been gathered by studies in several areas of investigation, all this knowledge has been unable to explain the pathogenesis of the condition. In many parts of the world, the origin of relevant problems in the cardiovascular area is still related to rheumatic fever, with significant rates of morbidity and mortality. In developing countries, the disease is a risk because of its cardiac sequels, being the most important cause of acquired heart disease in the young. Its potential resurgence now emphasises its burgeoning significance in the developed world. Several factors, nonetheless, have contributed to a changing pattern of rheumatic fever. The decline in frequency and seriousness during the last decades has been attributed to changes in the host and environment, besides possible modifications in virulence of the streptococcus. Other factors influencing the changes include the increased ability to diagnose the disease through the establishment of stricter diagnostic criterions, as well as the strategies of primary and secondary prophylaxis for controlling recurrences. Furthermore, procedures to assess damage to the heart, and to improve the cardiac performance, have resulted in more effective health care by the introduction of technological advances, mainly Doppler echocardiography, valvoplasty, and surgical valvar replacement and repair.