Distribution and determinants of heart disease vary greatly between high-income countries and sub-Saharan Africa where rheumatic heart disease (RHD) is a major public health challenge. (1) RHD is the predominant cause of valve disease in Africa, (2) resulting in Africa having the highest prevalence of cardiac disease in children and young adults .(1) Cumulative effects of poverty, social instability and lack of infrastructure, resources and awareness contribute to the underestimated impact of RHD. (1,2) Studies from Africa confirm that RHD is the main cause of cardiac morbidity and mortality from heart surgery. (1)(2)(3) Mitral valve disease, in the form of mitral stenosis and mitral regurgitation, is the commonest form of valve disease and its treatment usually involves surgical repair or replacement. These surgical procedures are highly invasive and not without risk of complications. (3) In South Africa, data on the management and outcomes of mitral valve surgery are limited. (4) Operative mortality in mitral valve replacement surgery is 5% -6% and 1% -2% in mitral valve repair. (5) Complications associated with mitral valve surgery are commonly related to cardiopulmonary