The mean ages of the two groups (RMVD and DMVD) were 51 and 56 years, respectively. The demography of the RMVD group represents an age shift from juvenile rheumatic heart disease (RHD) to a stage of a burn-out RHD in which structural deterioration process of the rheumatic mitral valve has ceased and stabilized. The pathology of the mitral valve apparatus is presented with annular dilatation or mixed lesion. In absence of calcification valve repair is feasible in experienced hands, otherwise replacement is inevitable (2)