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This thesis investigates the substantial burden of Rheumatic Heart Disease (RHD), an autoimmune sequela of Group A Streptococcus infection, which is highly prevalent in countries such as Indonesia, affecting over a million people. RHD causes progressive valvular damage, leading to severe cardiac complications (like atrial fibrillation and pulmonary hypertension) and imposes a significant economic burden by affecting young, productive populations.

We found that many Indonesian patients with RHD presented with advanced disease stages. Using advanced echocardiography, our study demonstrated that the rheumatic etiology independently causes more severe Left Ventricular (LV) dysfunction than degenerative disease. Furthermore, the novel parameter Myocardial Work (MW) has been shown to detect subtle LV dysfunction and correlate with diminished functional capacity in patients with severe mitral stenosis, even when standard measures such as LV ejection fraction are preserved.

A systematic review confirmed the crucial importance of penicillin adherence in the secondary prevention of RHD progression. Regarding surgical management, the findings indicate that rheumatic mitral valve surgery has a higher 30-day mortality rate than non-rheumatic procedures, and valve repair does not offer a significant survival advantage over valve replacement, underscoring the necessity of customized surgical planning.

The thesis concludes by identifying the critical challenges in RHD management in developing countries, including a lack of data, low awareness, and resource limitations, which cause delayed diagnosis and poor outcomes. It proposes strategies such as enhanced risk stratification, systematic follow-up, and the establishment of networked Heart Valve Clinics to optimize care and reduce costs.