Abstract
To the Editor: Marijon and colleagues1 base their arguments on a phenomenon not observed by them during their study on rheumatic heart disease (RHD). They assume that “pathophysiologically, repeated rheumatic carditis can result in subvalvular or valvular thickening before the development of leaflet retraction and thereby regurgitation.” They further state, “In adding the diagnostic criterion of morphological valve changes, otherwise well defined in more advanced rheumatic valve lesions, we have detected many children with subclinical RHD but without significant valve regurgitation who would not be eligible for secondary RHD prophylaxis under current international guidelines.” A phenomenon of dissociation between mild- to moderate-grade RHD-like valve abnormalities and significant regurgitation in …
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