IJCS | Volume 32, Nº5, September/October 2019

436 1. Brasil. Ministério da Saúde. Sistema de Informações Hospitalares do SUS (SIH/SUS). [Acesso em 2016 Dez 9]. Disponível em: http://w3.datasus . gov.br/datasus/datasus.php. 2. Nat Rev Dis Primers. ; 2: 15084. doi:10.1038/nrdp.2015.84.Carapetis JR, Beaton A, Cunningham M W. et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers.; 2: 15084 doi:10.1038/ nrdp.2015.84,available in PMC 2018 February 13. 3. Roberts S, Kosanke S, Terrence Dunn S, Jankelow D, Duran CM, CunninghamMW. Pathologic mechanisms in rheumatic carditis: Focus on valvular endothelium. J Infect Dis 2001;183:507-11. 4. Krishna Kumar R., Rammohan R, Narula J, Kaplan EL. Epidemiology of streptocoecal pharyngitis, rheumatic fever and rheumatic heart disease. In: Narula J, Virmani R, Reddy KS, Tandon R, editors. Rheumatic fever: Washington DC: Amer., Registr. of Path. AFIP; 1999. p. 41-68. 5. Watkins DA, Beaton AZ, Carapetis JR et al. Present Status of Rheumatic Heart Disease. JACC 2018, vol . 7 2 , N0 . 1 2 , september 18: 1 3 9 7 – 4 1 6. 6. Lemos FMF, Herdy GVH, Valete COS, Pfeiffer ET. Evolutive Study of Rheumatic Carditis Cases Treated with Corticosteroids in a Public Hospital. Int J Cardiovasc Sci. 2018;31(6)578-584. 7. Cilliers A, Manyemba J, Adler AJ, Saloojee H. Anti-inflammatory treatment for carditis in acute rheumatic fever. Cochrane Database Syst Rev. 2012; 6:CD003176. This systematic review confirms that there is no evidence-based medical treatment that alters the outcome of carditis in ARF. 8. Finucane K, Wilson N. Priorities in cardiac surgery for rheumatic heart disease. Glob Heart. 2013; 8:213–220. [PubMed: 25690498]. References Soares AM Rheumatic Heart Disease - How are we in 2019, have we evolved? Int J Cardiovasc Sci. 2019;32(5):435-437 Editorial The real benefit of using corticosteroid therapy for ARF remains controversial. Corticosteroids reduce the inflammatorymarkers of ARF, especially fever and acute phase reactants, and have been widely used in severe acute carditis with heart failure, even though there is little evidence showing that their superiority over usual strategies such as bed rest, fluid restriction and cardiac medications. 5 Most articles do not show evidence for improvements in the severity of chronic valvular heart disease with corticosteroids one year after ARF. There is a strong argument for the need of amulticenter randomized clinical trial of corticosteroids versus placebo in ARF, using echocardiographic endpoints for acute carditis (6 weeks) and chronic valvular disease (6 months to 1 year). Such a study would need to be powered to account for the natural improvement of carditis after the acute phase but would provide an evidence-based approach to corticosteroid therapy for active rheumatic carditis. Corticosteroids have been frequently used to treat severe carditis around theworld. Similarmulticenter studies of other immunomodulators, informed by an expanded understanding of ARF immunopathogenesis, could eventually be considered, but there is no role for small, underpowered studies. 7 Cardiac surgery is usually deferred until the acute inflammation is subsided so that the repair is technically easier, and a more durable repair can be achieved. The philosophy of cardiac surgery in the young is to repair rather than to replace the mitral valve. 8 A retrospective report of 81 patients aged 3–19 years comparing mitral valve repair versus replacement showed not only a lower morbidity (less endocarditis and no thromboembolism), but also that the need for reoperation was not increased in the repair compared with the replacement group. 9 Large-scale screening programs aimed at disease control and not only at defining RHD epidemiology are required. Economic and cost-effectiveness evaluation could then be calculated. In the meantime, mathematical models using existing data could allow the prediction of the effectiveness of these programs. Realistic estimates of disease burden should add impetus to producing an effective GAS vaccine. Moreover, echocardiography would have an important role in trials assessing 10 the safety and the efficacy of GAS vaccines, and in the RHD epidemiology for targeting vaccine delivery. 11 Despite the disappearance of RHD in developed countries, the disease is still unstoppable in poor and developing countries. The recent REMEDY study documented high rates of disability and premature death in African and Asian countries. 12 In 2015, a civil society movement, the RHD Action, was launched to raise awareness and support countries. Broader societal engagement in advocacy efforts, with the involvement of citizens’ groups and nongovernmental organizations, is needed for the success of the ARF and RHD control. 2 In May of 2018, the World Health Assembly adopted a resolution to reinvigorate global and national RF/RHD prevention and control efforts. An arduous and constant work in the prevention of RHD must continue and gain strength. We take advantage of this editorial to thank the commitment and dedication of Professor Bongani Mayosi in RF eradication, Rachel Snitkowisk, who developed RF prevention projects that have spread all over Brazil and Cleonice CMota for all her dedication in this area, along with several others in our country. 13