Background: Rheumatic heart disease (RHD), a long-term complication of acute rheumatic fever (ARF), is still the main cause of paediatrics acquired heart disease, premature deaths and disabilities among indigenous Egyptian populations. It influences mostly children and young adults. Objective: This study aimed to estimate the prevalence of RHD detected by echocardiographic screening among school children (age 5-18) in Mansoura District at Dakahlia governorate, Egypt. Method: This descriptive cross-sectional study included 4847 school children recruited from the governmental urban & rural schools considering the pattern of population distribution in rural and urban areas in Mansoura. A predesigned structured questionnaire was given to parents of children. All children were examined by echocardiographic examination to detect RHD. Results: The prevalence of RHD among studied group was 0.9 %. The most significant predictive factors for RHD were urban residence, overcrowding, positive surgical history of tonsillectomy and being on long acting penicillin. Conclusion: The utilization of echocardiographic screening for diagnosing RHD can prevent both its over- and under-diagnosis