Objective: To analyze the value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in evaluating cardiac structure and valvular function in patients with rheumatic heart valve disease. Methods: Sixty patients with rheumatic heart valve disease who were treated in our hospital and the Second Affiliated Hospital of Nanchang University from January 2023 to January 2024 were selected. All of them underwent TTE and TEE. Surgical results was taken as the gold standard to compare the results of TTE and TEE, and analyze their value in detecting cardiac structure and valvular function. Results: Left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDd) and left ventricular end systolic diameter (LVESd) detected by the two methods were comparable (P>0.05). With surgical results as the gold standard, the detection rates of cardiac structural abnormalities (left ventricular hypertrophy, left atrial enlargement and left ventricular enlargement) and valvular function abnormalities (simple stenosis, simple regurgitation and stenosis with regurgitation) using TTE were significantly higher than using TEE (P<0.05). Conclusion: Compared with TEE, TTE can better help to evaluate cardiac structure and valvular function in patients with rheumatic heart disease, and can more accurately detect abnormalities in cardiac structure and valvular function.