Patient description: A 5 months old male brought to the pediatrics surgery clinic with the complaint of empty scrotum at the right side. The baby boy is a first child who was born at the age of 38 weeks with NVD from a healthy mother. The mother had a normal pregnancy with no complication. The baby boy weighted 3200 gr with the height of 50 cm. He is breast feeding and now weighted as 6.5 kg with the height of 62 cm. He has no developmental delay in the physical assessment. There is a palpable testis is the left scrotum with non-palpable testis in the right scrotum. The penis is normal in shape and size and he is not circumcised. The diagnostic laparoscopy showed an abdominal undescended testis.

Clinical trial eligibility criteria: eligible ages (years): 0.0-999.0,  Rheumatic Heart Disease Rheumatic Fever Endomyocardial Fibrosis Acquired Heart Disease Rheumatic Heart Disease: Patients with a definite diagnosis of rheumatic heart disease based on the 2006 World Health Organization/National Institutes of Health Joint (http://www.niaid.nih.gov/topics/strepThroat/Documents/groupasequelae.pdf) controls who do not meet this criteria. The diagnosis will be made by a cardiologist on our team. The method of screening and recruitment will be specific to each of our two sites: Uganda Heart Institute and University of Lagos, Nigeria. -Uganda Heart Institute: --recruitment will be conducted from an existing cohort of patients initially recruited by members of our team from 21 randomly selected schools in Uganda. Participants meeting the noted above for RHD will be considered cases and those who do not will be considered controls. Additionally, parents will be invited to participate as controls. For controls, only children over age 10 will be considered as this increases the likelihood of exposure to S. pyogenes. The initial study was approved by the institutional review boards of the Children s National Medical Center (Washington,D.C.), Makerere University (Kampala, Uganda), and the Ugandan Ministries of Health and Education University of Lagos: --This program will be modeled after the Uganda program. Participants will be screened for RHD at the College of Medicine or at randomly selected schools. Participants meeting for RHD will be consented as cases and those negative for RHD will be consented as controls. Additionally, parents will be invited to participate as controls. For controls, only children over age 10 will be considered as this increases the likelihood of exposure to S. pyogenes Endomyocardial Fibrosis (EMF) Cases: the study will patients with a diagnosis of EMF based on echocardiography, history, and physical exam performed by cardiologist;on our team Over 50 patients have been identified at the Uganda Heart Institute with EMF and will be contacted for study participation; additionally, newly diagnosed patients at the Uganda Heart Institute will be offered participation Controls: Geographic and age matched controls will be used for association study. Controls will be disease free, based on above criteria. We will controls less than 15 years of age based on disease peak around age 10. Controls will be selected from those being screening for RHD  -Anyone unwilling to provide informed consent (for themselves as adults, or on behalf of their children as minors) or assent