The average annual incidence of acute rheumatic fever in children aged 5-15 years is 15.2 cases per 100,000 population in Fiji[2] compared with 3.4 cases per 100,000 population in New Zealand,[3] and it less then 1 case per 100,000 population in the United States. Although rheumatic fever was previously the most common cause of heart valve replacement or repair, this disease is currently relatively uncommon, trailing behind the incidence of aortic stenosis due to degenerative calcific disease, bicuspid aortic valve disease, and mitral valve prolapse.