Rheumatic valvular disease in children is common in underprivileged countries and often damages the tricuspid valve (in addition to the mitral and aortic valves). Fifteen children aged 12 to 16 years underwent tricuspid valve surgery. Fourteen were graded as Class IV disability; five were operated during rheumatic activity. The tricuspid valve was replaced in ten patients, four had annuloplastic procedures and one underwent tricuspid commissurotomy. There was one operative death and four late deaths. Eight of the ten long-term survivors are in Class I and the remainder in Class II functional ability. It may be concluded that in children who can be protected from additional bouts of carditis and thromboembolism, the surgical treatment of advanced multivalvular disease including the tricuspid valve is most rewarding, and dramatic clinical improvement with return to normal or near-normal hemodynamics may be expected.