A GP says further heart surgery for rugby player Robbie Fruean should serve as a wake-up call to the potential dangers of rheumatic fever.
The Crusaders centre is to have valve replacement surgery this week, leaving him out of action for the remaining Super Rugby season.
It's the second round of heart surgery for the 24-year-old, who was first operated on when he was 20 after contracting rheumatic fever in his late teens.
Though not all cases of rheumatic fever lead to heart inflammation, Porirua GP Larry Jordan says when inflammation does occur it can cause the heart valves to leak and become scarred and damaged.
Dr Jordan says surgery and medical treatment can help a lot but the consequences of rheumatic fever on the heart can be life-long.
He says rheumatic fever starts with a particular type of sore throat and must be treated quickly to prevent heart problems later on.
Crusaders Coach Todd Blackadder says if the surgery goes well he has no doubt Fruean will be back playing for the Crusaders next year, while the team's doctor, Deborah Robinson, says the player is otherwise fit and healthy which should help his recovery.