In heart valve disease, the simultaneous involvement of 2 or more valves is called combined heart valve disease. The most common cause of combined heart valve disease is rheumatic heart valve, of which the most common combination form: combined mitral and aortic valve valve disease. Briefly describe the disease: mitral stenosis and aortic valve insufficiency. 1, pathophysiology: mitral stenosis combined with aortic valve insufficiency is the most common combined valve disease in clinical practice. Both lesions can produce corresponding pathophysiologic changes, and both can alter the left ventricular volume load. However, because of the interaction between the two, the effects on LV volume load are opposite. This combination is usually said to be more severe with mitral stenosis and less severe with aortic valve insufficiency. The pathophysiologic changes are similar to those in patients with mitral stenosis alone. When aortic valve insufficiency is also more severe, it can cause complex pathophysiologic changes. The mitral valve limits left ventricular filling and relieves the effect of aortic insufficiency on left ventricular volume; conversely the presence of aortic insufficiency also reduces left ventricular narrowing due to mitral stenosis, so left ventricular wall changes occur later and there may be only mild left ventricular enlargement and pulmonary hypertension is usually present. 2, Clinical manifestations: Patients mostly have shortness of breath after exertion, decreased activity endurance, and may have dyspnea. The left ventricular filling is obstructed due to severe mitral stenosis, reducing the typical symptoms of aortic valve closure insufficiency, such as watery pulse, gunshot sound, capillary pulsation sign, and large pulse pressure lights. A mild diastolic splash murmur can be heard in the 2nd intercostal space at the left sternal border. This murmur is produced in 90% by aortic valve disease and in 10% by relative pulmonary valve insufficiency due to severe pulmonary hypertension. There is a typical rumble-like diastolic murmur in the apical region, but severe aortic valve insufficiency can also mask the signs of mild mitral stenosis, and special attention should be paid to the presence of first heart sound hyperactivity and open valve sounds. 3.Auxiliary examinations: Cardiac ultrasound, electrocardiogram, cardiac catheterization and angiography can clarify the diagnosis. 4, Indications for surgery: Treatment principles: must be based on the improvement of hemodynamics and ventricular function and the possible benefits of medical therapy, while considering the etiology and using different surgical approaches according to the different pathophysiology. Mitral stenosis combined with aortic valve insufficiency requires surgical treatment when clinical signs or pulmonary hypertension are present. If mitral stenosis is predominant and aortic valve insufficiency is mild, surgery can be performed only on the mitral valve, often using percutaneous mitral balloon dilation, or mitral valve replacement. If the aortic valve is predominantly closed, mitral stenosis is a secondary lesion, and left ventricular insufficiency should be treated with early surgery. 5.Surgical procedures: (1) valve replacement or repair surgery; (2) the choice of valve type should be combined with the patient’s weight and heart size. It should also be noted that the two valve types should be matched as much as possible, and the type of mitral valve should be determined based on the type of the aortic valve. 6, surgical outcome evaluation: The safety of single valve replacement surgery is relatively high. The mortality rate of double valve replacement surgery is currently reported to be between 6-17%, and the 5-year survival rate is between 60% and 88%.