Medical, interventional, and surgical management of rheumatic heart disease

Rheumatic heart disease (RHD) is a lifelong chronic condition with complex pathogenesis and major management challenges in regions where it is endemic. Therapeutic difficulties stem from the need for prolonged medical treatment and lifelong surgical planning in a predominantly young population. Gaps in our understanding of optimal medical and surgical treatment strategies persist, in part because clinically apparent RHD has become uncommon in high-income countries, where most therapeutic innovations historically originate, limiting research investment in this population. This review summarizes established and emerging aspects of the medical management of RHD, its major complications, and available surgical and transcatheter interventions with a focus on the mitral valve. Ongoing research continues to expand the evidence base for RHD care, but parallel efforts to strengthen health systems are essential to ensure effective delivery of available therapies. Sustained global collaboration, research partnerships, and policy initiatives are critical to improving outcomes for individuals living with RHD worldwide.