This study is based on a retrospective analysis of 144 autopsied cases of rheumatic heart disease. Majority of cases (79%) were chronic and 21% were acute in nature. The mortality was high and was maximum below the age of 30 years. The males predominated over females. A high incidence of organic tricuspid valve involvement was observed (45.8%). Tricuspid stenosis was observed in 3 cases. Latter was associated with aortic and mitral valve involvement. Mitral stenosis was severe in all the three cases. Criteria, both gross and microscopic for the involvement of the tricuspid valve have been described. Involvement of mitral valve either singly or in combination with the other valves, emerged to be the commonest. Changes observed in the lungs in these cases have been dealth with briefly. Pulmonary vascular changes were usually severe, particularly in the juvenile age group.