Rheumatic heart disease.

Rheumatic heart disease seems in many ways emblematic of an older era in medicine, without any prospects of new development or change in the current era. Many new findings have come to light in the past few years regarding this illness, which has a relatively low prevalence in the United States. Not only have the diagnostic Jones criteria for acute rheumatic fever changed, but substantial advances have been made in the use of penicillin prophylaxis for recurrent rheumatic attacks, the use of mitral valve repair or reconstruction for rheumatic mitral regurgitation, the management of rheumatic, aortic, and mitral valve disease, and the application of balloon commissurotomy for mitral stenosis. This review details some of these advances.