A case of severe rheumatic mitral stenosis was found to have multiple echodense masses attached to the ventricular surface of the mitral valve and papillary muscle at preoperative 2-dimensional echocardiography. Subsequent surgery involved mitral valve replacement and excision of the masses. Complete excision was confirmed by intraoperative transoesophageal echocardiography. Histologic examination of the surgical specimens showed typical papillary fibroelastomas. This is the first case report of multiple papillary fibroelastomas in association with rheumatic valvular disease demonstrated by 2-dimensional echocardiography.