China is a region with a high incidence of esophageal cancer and is experienced in esophageal cancer surgery. However, there are not many reports of radical esophageal cancer surgery for patients with esophageal cancer combined with severe rheumatic heart disease, post multiple valve replacement, and cardiac insufficiency. Patient Liu XX , male 62 years old, was treated with mitral + aortic valve replacement + tricuspid valvuloplasty under general anesthesia extracorporeal circulation on February 14, 2003 for rheumatic heart disease, combined with valvular disease and class IV cardiac function 11 years ago, and recovered smoothly to class II cardiac function after the operation. In the past six months, progressive dysphagia was observed, and only a liquid diet could be eaten at the time of medical consultation. Gastroscopy revealed a narrowing of the lower and middle esophagus, about 6-7 cm long, filling defect and mucosal destruction; biopsy pathology was reported as squamous cell carcinoma. No distant metastases were detected by CT, B-mode ultrasound and other examinations. Preoperative review of cardiac echocardiography showed that the implanted artificial mitral valve and aortic valve were flexible with no perivalvular leakage; tricuspid valve had mild-moderate regurgitation; left ventricular EF was 42% and cardiac function was grade III. After adequate preoperative preparation, radical resection of middle and lower esophageal cancer was performed on January 7, 2014 under general anesthesia through a left anterolateral thoracic incision into the chest. Intraoperatively, it was found that the tumor in the middle and lower esophagus, about 7X4X4CM, invaded the outer membrane of the esophagus. Due to the significant enlargement of the left ventricle and left atrium, the middle and lower esophagus was squeezed into the right side of the chest. The lower and middle esophagus was resected freely, the left diaphragm was opened to free the whole stomach, and the mediastinal and abdominal lymph nodes were cleared. The stomach was lifted into the thoracic cavity and an esophagogastric end-lateral anastomosis was performed with the stump of the esophagus, and the anastomosis was located behind the aortic arch. Postoperatively, cardiac diuretic nutritional support was given, and the volume of nasal enteral nutrition solution was gradually increased from the second postoperative day. On the 10th postoperative day, we resumed a liquid diet via mouth. On the 14th postoperative day, he resumed eating semi-liquid diet and was discharged with clinical cure. Discussion: Radical surgery for esophageal cancer is very traumatic, combined with severe rheumatic heart disease, after heart multivalve replacement, cardiac insufficiency patients with high surgical risk, whether to take radical surgery is still controversial. The authors experienced two main points for this patient: First, the maintenance of cardiac function, preoperative cardiac diuresis, oxygenation, infusion of polarizing fluid, and maintenance of water-electrolyte balance. Cardiac ultrasound and coronary angiography were performed to exclude organic cardiac lesions. Intraoperative micro-pump infusion of dobutamine and nitroglycerin was used to control fluid balance and maintain the ventricular rate and blood within normal limits, which continued to be maintained postoperatively until the third postoperative day when the condition stabilized and was gradually discontinued. The amount of postoperative rehydration is large, so pay attention to the amount of fluid infusion per unit of time and achieve balanced input. Resume intranasal enteral nutrition as early as possible to reduce the direct cardiac load increased by the large amount of infusion. Second, the perioperative anticoagulation problem, after admission to the hospital, stop using warfarin orally and switch to subcutaneous injection of low-molecular heparin, stop using low-molecular heparin 1 day before surgery, check the coagulation four basic normal, you can operate. The drainage tube was removed on the third postoperative day, and warfarin 2.5 mg crushed via 12-finger nutritional tube was given nasally once a day. It is sufficient to maintain PT within 20 seconds and INR around 1.5. Other treatment is as usual for postoperative management of esophageal cancer patients. As long as attention is paid to perioperative management, patients with esophageal cancer combined with cardiac multivalve replacement and cardiac insufficiency still have a chance for radical surgical treatment and can obtain good results.