MS is one of the major causes of morbidity and mortality, with rheumatic heart disease still being the most common cause worldwide. Etiopathogenesis includes the chronic inflammatory disease process affecting the heart valves due to cross reactivity of streptococcal antigens with the cardiac myosin. Valve neovascularization, fibrosis and chronic inflammatory infiltrate are consistently present in most of the resected mitral valve specimens with a suspected history of RHD. Although Aschoff nodules are rarely seen in histopathological specimens, itis the pathognomonic feature of rheumatic valvular heart disease. Number of Aschoff nodules may vary but their presence does not indicate the activity of the disease process. Presence of “bread and butter” fibrinous pericarditis and acute rheumatic vegetations denote activity in cases with RHD.