Updates and future perspectives on rheumatic heart disease

Rheumatic heart disease (RHD) is a leading cause of cardiac disease among children in developing countries and in indigenous populations of several industrialized countries. Valve damage may lead to irreversible valve dysfunction and heart failure. The disease has been almost eradicated in western countries with the development of living conditions and prevention policies, including primary and secondary prevention. Although Italy experienced a comparable RHD epidemiological revolution over the past decades, some regional outbreaks of the disease have been recently reported according to the increased burden of immigrants. Therefore, RHD remains a major health problem. Over the past 5 years, echocardiographic screening has revealed a higher RHD burden than previously thought by identifying children with mild features of the disease. If screening programs are to identify additional cases of RHD, parallel improvements in the systems that deliver secondary prophylaxis are essential. However, the natural history of RHD in children with subclinical abnormalities detected by echocardiographic screening remains unknown, and long-term follow-up studies are needed to evaluate the clinical importance of early signs (subclinical/borderline disease). This article reviews RHD from the epidemiological background to the clinical interpretation of echocardiographic assessment and international prevention strategies.