Valve surgery in acute rheumatic heart disease. One- to four-year follow-up.

Six patients with acute rheumatic carditis and intractable left ventricular failure, all in class 4 NYHA classification, underwent successful valve surgery combined with medical therapy. Two-dimensional echocardiography and Doppler studies showed all of them to have left ventricular dilatation, with good systolic function, together with severe mitral regurgitation; two patients also had severe aortic regurgitation. Over a mean follow-up period of two years, no mortality was recorded, and all six patients were in NYHA class 1-2. We conclude that valve replacement is not contraindicated in acute rheumatic carditis and may be preferable to repair.