Chapter 54. Mitral Valve Disease: Indications for Surgery

  1. Salim Yusuf DPhil, FRCPC, FRSC Research Chair Professor of Medicine Director Vice President Research2,3,4,
  2. John A Cairns MD, FRCPC Professor of Medicine Former Dean5,
  3. A John Camm MD British Heart Foundation Professor Head of Cardiac6,
  4. Ernest L Fallen MD, FRCPC Professor Emeritus7 and
  5. Bernard J Gersh MB, ChB, DPhil Consultant Professor of Medicine8
  1. Blase A Carabello MD Professor Vice-Chairman

Published Online: 21 MAY 2010

DOI: 10.1002/9781444309768.ch54

Evidence-Based Cardiology, Third Edition

Evidence-Based Cardiology, Third Edition

How to Cite

Carabello, B. A. (2009) Mitral Valve Disease: Indications for Surgery, in Evidence-Based Cardiology, Third Edition (eds S. Yusuf, J. A. Cairns, A. J. Camm, E. L. Fallen and B. J. Gersh), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444309768.ch54

Editor Information

  1. 2

    McMaster University, Canada

  2. 3

    Population Health Research Institute, McMaster University, Hamilton Health Sciences, Canada

  3. 4

    Hamilton Health Sciences, Hamilton, Ontario, Canada

  4. 5

    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

  5. 6

    St George's University of London, London, UK

  6. 7

    McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada

  7. 8

    Mayo Clinic College of Medicine, Rochester, MN, USA

Author Information

  1. Department of Medicine, WA Tex and Deborah Moncrief Jr. Center, Baylor College of Medicine, Medical Care Line Executive, Veterans Affairs Medical Center, Houston, TX, USA

Publication History

  1. Published Online: 21 MAY 2010
  2. Published Print: 13 NOV 2009

ISBN Information

Print ISBN: 9781405159258

Online ISBN: 9781444309768



  • Rheumatic fever;
  • Prevention;
  • Acute management;
  • Steroids;
  • Penicillin


Rheumatic fever and chronic rheumatic valvular heart disease remains an important cause of acquired heart disease in the developing countries of Africa and Asia. While the precise pathogenetic mechanisms remain unclear the causative role of infection with the group A beta-hemolytic streptococcus is undisputed. Early aggressive treatment of this is important in primary prevention, and long-term prophylaxis against recurrent infections essential in secondary prevention. There has been disappointingly little progress in terms of good evidence as to how best the acute attack should be managed. While eradication of the disease depends on improvement in socioeconomic circumstances much can be achieved by a structured approach to community education, patient identification and effective diagnosis, treatment and prophylaxis.