Valve replacement in acute rheumatic heart disease

Children with severe rheumatic valvular insufficiency have a grave prognosis. Valve replacement in these patients is often delayed because of the fear of operating during the active phase of the disease. Four cases of successful valve replacement during active rheumatic fever (RF) are presented. Review of the literature revealed 5 additional cases. The relative risks of medical therapy and valve replacement are assessed in both active and inactive childhood rheumatic disease. Guidelines for selection of surgical candidates are discussed. We believe that active RF is not a contraindication to valve replacement; rather, in certain cases long-term survival following valve replacement during active RF is far better than long-term survival with medical management.