The management of young patients with valvular heart disease is a difficult problem in developing countries. At our Institution, 765 valves were operated upon in 523 patients over a period of two years. Rheumatic etiology was seen in 70% of the valves and 60% of all the valves were repaired. The hospital mortality and morbidity in the form of thromboembolic episodes were less in the repair group; 35 valves in 26 patients had to be reoperated upon for instability of the primary repair. Despite this high and early reoperation rate in the repair group and considering the higher mortality plus the problems of anticoagulation and limited durability of bioprostheses in the replacement group, conservation of the patient's own valve remains a better alternative in the long-term.