Recommendations for the Use of Echocardiography in the Evaluation of Rheumatic Heart Disease: A Report from the American Society of Echocardiography

J Am Soc Echocardiogr. 2023 Jan;36(1):3-28. doi: 10.1016/j.echo.2022.10.009. Epub 2022 Nov 23.


Acute rheumatic fever and its chronic sequela, rheumatic heart disease (RHD), pose major health problems globally, and remain the most common cardiovascular disease in children and young people worldwide. Echocardiography is the most important diagnostic tool in recognizing this preventable and treatable disease and plays an invaluable role in detecting the presence of subclinical disease needing prompt therapy or follow-up assessment. This document provides recommendations for the comprehensive use of echocardiography in the diagnosis and therapeutic intervention of RHD. Echocardiographic diagnosis of RHD is made when typical findings of valvular and subvalvular abnormalities are seen, including commissural fusion, leaflet thickening, and restricted leaflet mobility, with varying degrees of calcification. The mitral valve is predominantly affected, most often leading to mitral stenosis. Mixed valve disease and associated cardiopulmonary pathology are common. The severity of valvular lesions and hemodynamic effects on the cardiac chambers and pulmonary artery pressures should be rigorously examined. It is essential to take advantage of all available modalities of echocardiography to obtain accurate anatomic and hemodynamic details of the affected valve lesion(s) for diagnostic and strategic pre-treatment planning. Intraprocedural echocardiographic guidance is critical during catheter-based or surgical treatment of RHD, as is echocardiographic surveillance for post-intervention complications or disease progression. The role of echocardiography is indispensable in the entire spectrum of RHD management.

Keywords: Echocardiography; Heart failure; Mitral stenosis; Pulmonary hypertension; Rheumatic heart disease; Valvular heart disease.

Publication types

  • Practice Guideline

MeSH terms

  • Adolescent
  • Child
  • Disease Progression
  • Echocardiography
  • Humans
  • Mitral Valve
  • Mitral Valve Stenosis* / diagnostic imaging
  • Rheumatic Fever* / complications
  • Rheumatic Heart Disease* / diagnostic imaging