Rheumatic Heart Disease in Children

A 9-year-old girl from rural Maharashtra presents with a 3-week history of polyarthralgia affecting her knees, ankles, and wrists. Her mother reports a sore throat 4 weeks ago that resolved without treatment. On examination, she has a new systolic murmur at the apex, best heard in the left lateral decubitus position. Her ESR is 68 mm/h and CRP is 4.2 mg/dL. Echocardiography shows anterior mitral leaflet thickening with restricted motion and mild mitral regurgitation. What is the most likely diagnosis?

A 12-year-old boy from Tamil Nadu with a history of acute rheumatic fever 18 months ago is brought to the clinic for routine follow-up. He has been on regular benzathine penicillin G prophylaxis. On examination, he has a diastolic murmur at the apex and a systolic murmur at the left sternal border. Echocardiography shows severe mitral stenosis with a mitral valve area of 0.8 cm², moderate aortic regurgitation, and left atrial enlargement. He is currently asymptomatic. What is the most appropriate next step in management?

Which of the following cardiac lesions is the MOST common valvular involvement in acute rheumatic fever?

According to the revised Jones criteria (2015), which of the following is NOT a major criterion for the diagnosis of acute rheumatic fever in a child without prior ARF?