**1. Introduction**

Valve disease still a significant health problem in the developed countries, In United states nearly 2.5% of the population has moderate or severe valve disease, with increased the prevalence for people older than 64 years and is 13% in those older than 75 years [1].

The commonest valve diseases in the elderly are calcific aortic valve disease and aortic dilation causing aortic regurgitation [2].

While rheumatic heart disease is the most prevalent pathology of valve disease globally, especially in the adolescent and young adults with a projected prevalence of 16–20 million, rheumatic fever is the most frequent trigger of valve disease in the young, particularly in Africa, India, the Middle East, South America, and parts of Australia and New Zealand, China, and Russia [3]. In western countries, the incidence of rheumatic disease declined in the latter half of the twentieth century, with the occurrence of transitory local episodes. In Africa, endomyocardial fibrosis is a common, poorly investigated pathology that leads to valve disease in all ages [4]. On the other hand, in the developed countries valve diseases of elderly predominate, particularly calcific aortic stenosis and functional mitral regurgitation, with a prevalence of 13% in those older than 75 years reported in North America [5–7].

Other pathological conditions like infective endocarditis and drug-induced valve disease (5-HT2B receptor agonists) are on the rise [8–10].

Structural biological valves deterioration would be the future burden on health resources world-wide; this is due to its current popularity as a therapeutic option even in young patients, mainly to avoid the complications of anticoagulation [11, 12].

Lack of equitable access to health care takes place in all countries, as a consequence of many complex economic and social forces. Because of the escalating technological cost of health care around the world, the situation is the same, even those industrially developed countries.

The salient global errand is the prevention of rheumatic heart disease, which would necessitate cooperation among social, political, and medical programs that lead to creating enhancements in living conditions by better housing, nutrition and improved access to health care [13–16]. Penicillin for streptococcal throat infections and secondary prophylaxis would continue to be a cornerstone in the global fight against rheumatic heart disease [17–19]. It is also reported that there was a natural reduction in the virulence of streptococcal serotypes, but it happened after the incidence of rheumatic fever had declined.

Most of the serum biomarkers that have been shown related to VHD are detecting secondary effects on the ventricular myocardium. Biomarkers associated with myocardial stress include the natriuretic peptides and GDF-15. Troponin is linked to myocardial necrosis, and the micro RNAs, ST2, and galectin-3 are associated with myocardial hypertrophy and fibrosis. Of these, the natriuretic peptides are the most widely studied, but they are not specific to VHD, and there is considerable overlap in serum levels between different clinical groups [20–22].
