Mortality rates for RHD in regions with no access to treatment can be as high as 20 per cent within six years of diagnosis, due to severe heart failure. Pregnancy is particularly associated with a high risk of mortality and morbidity. Where treatment is accessible, the aim is to reduce complications of RHD--treating heart failure and AF, and reducing the risks of thromboembolism and infective endocarditis. Once valve disease becomes symptomatic, valves need to be repaired or replaced. (6) Treatment of RHD is costly and uses a lot of resources--prevention is evidently far more cost-effective for both developed and developing nations.