Valve replacement will ameliorate CCF The question is about carditis in Rheumatic .fever. carditis is one of the major criterias for the diagnosis of Rheumatic fever. Carditis Carditis occur in 50-60% patients with acute Rheumatic fever carditis and resultant chronic rheumatic hea disease are the most serious manifestations of acute rheumatic fever. Rheumatic carditis is characterized by pancarditis with active inflammation of all the three layers of the hea : Myocardium - Pericardium - Endocardium Endocarditis Endocarditis (Valvulitis) which is manifested by one or more cardiac murmurs is universal findinv in rheumatic carditis whereas the presence of pericariditis or myocarditis is variable. Endocarditis or valvular damage is the hallmark of Rheumatic fever, the mitral valve is almost always affected sometimes together with Aoic valve. Serious and long tenn illness is entirely related to valvular hea disease. Pericarditis Pericarditis most commonly causes pericardial effusion which results in pleural friction rub on echocardiography and may occasionally cause pleuritic chest pain. Myocarditis Myocardial involvement is almost never responsible in itself for cardiac failure. Myocarditis perse plays little or any role in the morbidity of rheumatic fever. Evidence for absence of myocarditis playing any role in the morbidity and moality of rheumatic fever is based on the following. - Troponin 7(2-a marker of myocardial damage has been found not to increase during acute rheumatic .fever with carditis indicating absence of significant myocardial damage. - Radionuclide evaluations using antimyosin antibody indicates insignificant myocardial uptake (hence absence of significant damage) in the absence of pericarditis and C.C.F. - Myocardial biopsies during acute rheumatic fever with carditis have .failed to provide information regarding presence of myocarditis because of paucity of myocardial damage. - Echocardiographic evaluation of the left ventricular function indicates that the myocardial contractility (the capacity of myocardium to contract) remains normalQ even in the presence of C.C.F. - Pathological evaluation (biopsy) of the myocardium indicates that the amount of myocardial damage is insufficient to explain the moality. - Surgical replacement of mitral and/or aoic valve during acute rheumatic fever results in rapid control of CCF and decrease in hea size, despite investigational evidence for ongoing active rheumatic .fever. The surgical findings thus indicate that it is the acute hemodynamic overload secondary to valvular regurgitation which is responsible .for CCF.