The most commonly involved valve in rheumatic heart valve disease is the mitral valve, followed by the aortic valve. The vast majority of patients, about 70%, have mitral valve involvement, while some have aortic valve involvement, and some have both mitral valve and aortic valve involvement. The mitral valve is most often involved, causing stenosis of the mitral valve. Patients may experience clinical manifestations of mitral stenosis, such as dyspnea, cough, or even coughing up blood, thromboembolism, and in advanced stages, heart failure. Usually, the mitral valve is involved for more than 5 years after the patient has developed multiple infections of rheumatic fever before the clinical manifestations of mitral stenosis appear.