Rheumatic heart disease continues to be a significant public health problem in many developing countries and in some of the aboriginal populations in developed countries. Echocardiography has become indispensable in the assessment of valve lesions secondary to rheumatic heart disease. It confirms the rheumatic etiology of valvular abnormality as the features are quite typical in most cases. It also helps to exclude nonrheumatic causes of valve lesions. M-mode and cross-sectional echo helps to assess the severity of valve abnormality and its hemodynamic effects on the heart. Further, color flow imaging evaluates the flow across a valve, both qualitatively and quantitatively. Serial echocardiography plays a crucial role in the follow-up of patients with rheumatic heart disease and is very helpful for determining the timing of intervention. Recently, addition of real-time 3-dimensional echocardiography has further improved imaging of cardiac valves, especially the mitral valve.