A 13-year follow-up study was performed in 301 patients with rheumatic heart disease (RHD). Of these patient, 223 cases, 78 men (average age 59.3 years) and 145 women (average age 60.4 years), survived. Seventy-eight cases including 38 men (mean age of death 72.5 years) and 40 women (mean age of death 64.8 years) died. RHD consisted of 51% mitral valvular diseases, 40% combined valvular diseases and 9% aortic valvular diseases. The mean mortality for all patients with RHD was 25.9%. Seventy percent of the deaths were due to severe, chronic heart failure, sudden death and cerebral emboli. Atrial fibrillation was observed in 50% of the patients. Cerebral emboli occurred frequently in patients with mitral stenosis (MS), mitral stenoregurgitation (MSR) and combined valvular disease (CVD), which were associated with atrial fibrillation. However, cerebral emboli were rarely found in cases with MSR, CVD and aortic valvular disease with sinus rhythm. The mortality of cardiac surgery was low, 13.3%.