Background: chronic rheumatic heart disease (RHD) is still common in developing countries and associated with major complications and high mortality. Aim: to describe clinical characteristics of children with chronic rheumatic valvular heart disease. Patients and Methods: the study included fifty patients with chronic rheumatic valvular heart disease attending Assiut University Children Hospital over six months. Full through history and clinical examinations were done to all cases. All cases have been subjected to chest X-ray, standard 12-lead ECG, and echocardiography. Results: female patients were slightly commoner than male patients. Mitral valve was the commonest valve affected followed by aortic valve. Regarding ECG, left atrial hypertrophy was the commonest finding and mitral regurge was the commonest valve lesion. While, left atrial hypertrophy was the commonest finding in chest X-ray. Respecting echocardiography, there was slightly increased in left ventricular end diastolic diameter and left atrium. Heart failure was the most common complication that occurs in RHD patients. Patients' compliant with long acting penicillin (LAP) were more than non-compliant. Conclusion: echocardiography is the most important tool for evaluation of valvular heart disease. Left atrial hypertrophy is the commonest finding by ECG. There is increase in left ventricular end diastolic diameter and left atrium by echocardiography. Left atrial hypertrophy is the commonest finding in chest X-ray. Mitral valve is the commonest valve affected followed by aortic valve. Patients' compliant with LAP are more than non-compliant patients. Recommendation: echocardiography must be used as a screening tool for early detection of subtle cases of RHD. Application of control programs with special emphasis on the regular use of secondary prophylaxis.