Objective: This study aims to determine the correlation of vascular cell adhesion molecule-1 (VCAM-1) and circulating endothelial cells (CEC) with cardiac valves lesion severity and heart failure (HF) in rheumatic heart disease (RHD). Methods: A cross-sectional observational study using human peripheral blood samples of 36 children aged 6 to14 years old, divided into two groups: 18 RHD patients and 18 healthy controls group. The expression of CECs and VCAM-1 on CECs was investigated by using flow-cytometry method while the levels of soluble VCAM-1 (sVCAM-1) were obtained by using ELISA method. The severity of valve lesions was determined in a qualitative manner. Results: The average of CECs expression, VCAM-1 on CECs expression, and sVCAM-1 levels were significantly higher in the patient group than those of the healthy group. The expression of VCAM-1 on CECs was significantly different among mild, moderate, and severe regurgitation. Correlation analysis showed that the CECs expression had a significant correlation with HF. Moreover, correlation was found between expression of VCAM-1 on CECs and the severity of valve lesions. However, sVCAM-1 in plasma had no correlation either with HF or with valve lesion. Conclusion: The expression of VCAM-1 on CECs is associated with severe regurgitation while CECs level was correlated with HF. VCAM-1 on CECs may be considered a marker for the severity of functional regurgitation in RHD. CECs could be recommended as a measure for RHD with HF.