The vast majority of prosthetic valve designs are either mechanical prosthesis and bioprosthetic heart valves (BHV). Mechanical prostheses are fabricated from synthetic materials, mainly pyrolytic carbon leaflets mounted in a titanium frame. Tissue engineering (TE) offers the potential to create cardiac replacement structures containing living cells, which has the potential for growth and remodeling, overcoming the limitations of current pediatric heart valve devices. The purpose of this paper is to present a review of the structure-strength relationships for native and engineered heart valve tissues.