Patients with rheumatic heart disease generally present with valvular insufficiency or severe stenosis. If the patient's heart is enlarged and the ejection fraction significantly decreases, for example, if the left ventricular diastolic diameter is greater than 75, and the ejection fraction is less than 30%, the surgical outcome may be poor. This is particularly the case if there is associated pulmonary arterial hypertension, which may lead to no improvement in condition after surgery, indicating a poor surgical outcome. However, if the patient has severe stenosis or insufficiency of the valve function, not performing surgery could further worsen the condition.