Valvular heart disease is characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary. The most common diagnoses that must be considered are severe aortic stenosis, severe aortic regurgitation, and severe mitral stenosis. Severe mitral regurgitation precipitated by infective endocarditis, acute myocardial infarction, and ruptured chordae or flail mitral leaflet in patients with myxomatous mitral valve prolapse. Rheumatic aortic stenosis remains a common problem in Asia, Africa, the Middle East and Latin America. The patient’s age at the time of diagnosis usually gives a reasonable assessment of the underlying disease. Mitral stenosis is almost always due to previous rheumatic fever. It takes more than or equal to 2 years after the rheumatic episode for sufficient fibrosis and thickening of the valve to produce the typical murmur. Mitral valve prolapse is said to be a common condition. The incidence of mitral valve prolapse has been exaggerated because of the inclusion of many patients with a normal variant of mitral valve closure but with correct coaptation; leaflets may billow only slightly into the left atrium with normal coaptation.