—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.