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In the Middle Eastern states, in the developing countries of Southeast Asia and Africa with their vast populations, in the poverty-stricken Central and South American lands, and in other underprivileged parts of the world, rheumatic heart disease is a major problem with a high morbidity and mortality. In these areas the disease frequently attacks children, in whom the course is much more malignant than in adults. This re sults in severe pathologic changes in the cardiac valves from an early age. Stenosis of the mitral valve is one of the more common lesions, and closed mitral commissurotomy...