—We appreciate Dr Veasy's comments and agree that Doppler echocardiography is a powerful and useful diagnostic tool. However, the presence of "silent" mitral regurgitation in normal subjects causes concern about over-reliance on this tool in diagnosing rheumatic fever carditis.1-3 More studies are needed to differentiate abnormality from normalcy. In the meantime, we chose a conservative stance regarding this point. We also agree that serial use of echocardiography/Doppler in patients with proven rheumatic fever and carditis is useful. It is important and prudent to assess continuously the natural progress of the disease using all available means.
Dajani AS, Allen HD, Taubert KA. Echocardiography for Diagnosis and Management of Rheumatic Fever-Reply. JAMA. 1993;269(16):2084. doi:10.1001/jama.1993.03500160050018