Abstract Rheumatic heart disease (RHD) continues to be responsible for the loss of millions of young productive lives worldwide, with a disproportionate burden being borne by the underdeveloped and economically disadvantaged strata of society. There is an urgent need to develop approaches to identify RHD in its early stages and reverse it before it can cause significant valvular damage. This is especially relevant for the developing world where advanced cardiac surgery is inaccessible to many. Research over the last decade has made it possible to diagnose subclinical or latent RHD through systematic echocardiographic screening using standardized criteria, which can pick up early disease better compared to clinical screening alone. Furthermore, initial studies show promise that timely institution of penicillin prophylaxis can lead to regression of such latent disease. This brief review summarizes the current state of the field in this regard and outlines some of the challenges in translating this concept from benchside to public health policy.