In China, rheumatic heart valve disease accounts for about 50% of all cardiovascular diseases, and mitral and aortic valve valve lesions account for more than 50% of these patients, for which mitral and aortic valve valve replacement is the most effective treatment. Nowadays, there are more and more reports about valve replacement surgery for giant heart valve diseases, but the cardiothoracic ratio of the heart is mostly used as the criterion for the classification of giant hearts and the judgment of the surgical outcome, however, giant hearts are not all critical patients, and their surgical outcome varies greatly, and the measurement of such critical patients is based on the different roles played by each heart chamber in the heart pump function, the degree of enlargement or reduction of each heart chamber, and the difference in myocardial damage. The differences in surgical risk and postoperative outcome are determined, such as the difference in surgical outcome between the left atrium of a huge heart with postoperative complications and a large or small left ventricle. Therefore, the size of the heart cannot be used as a criterion to measure the severity of the disease, and the function of the left ventricle is the key factor to determine the surgical outcome left ventricular enlargement or reduction, which has a high surgical mortality rate, a high incidence of early postoperative complications especially the occurrence of low cardiac output and arrhythmias, and a great difference in the long-term outcome, while there is no significant relationship with the cardiothoracic ratio Therefore, we divided the giant heart valve disease into three types, according to the size of the heart chambers in order to judge the prognosis of surgical outcome. For type I left and right atrial and right ventricular enlargement, small left ventricle (LVEDd<45mm); significant reduction in left ventricular volume dominated by severe mitral stenosis, long-term left ventricular underfilling, resulting in left ventricular myocardial atrophy, myocardial degeneration or fibrosis, and left ventricular hypofunction, as well as hemodynamic compromise due to long-term severe mitral stenosis, elevated left atrial pressure, left atrial enlargement, and secondary pulmonary stasis. Pulmonary hypertension (moderate or higher) with increased right ventricular ejection resistance, right ventricular enlargement, tricuspid regurgitation, and mostly associated with left atrial thrombus. For such patients, in addition to complete removal of left atrial thrombus, it is reported that the key is the choice of prosthetic valve size, based on the patient's weight or body surface area, choose a small 1~2 model prosthetic valve (central flow type), and the incidence of low heart displacement is significantly reduced. Because preoperative patients with low long-term left ventricular preload when the preload is suddenly changed, the left ventricular myocardial incompetence completely ejects blood from the left ventricle and low heart displacement occurs, resulting in a high incidence of postoperative low heart displacement and high operative mortality. Therefore, the postoperative period of ventilator-assisted breathing is prolonged to reduce the burden on the left ventricle, and the use of positive myocardial inotropic drugs, such as dobutamine, dobutamine, epinephrine and amrinone, is enhanced. In particular, the application of small doses of dobutamine (2-4 Lgkg-1min-1) has been discontinued until 2-3d after circulatory stabilization, otherwise it is difficult to correct postoperative low cardiac output. For type II, biventricular and right ventricular enlargement (LVEDd45~69mm) is often associated with a long course of rheumatic joint valve damage, secondary to left ventricular enlargement with moderate or higher pulmonary hypertension and right ventricular decompensation and moderate or higher tricuspid valve closure insufficiency, with a predominantly generalized enlargement of the heart and poor cardiac function reserve. The manifestation is total heart failure, with varying degrees of damage to various organs. Preoperative improvement of cardiac function, reduction of pulmonary artery pressure, good intraoperative myocardial protection, and tricuspid valve shaping should not be neglected, which can reduce postoperative complications and have better long-term outcome. For type III, large left ventricle (LVEDd>70mm), aortic and mitral valve closure insufficiency is predominant in this type of patients. Long-term LV volume overload, with the development of the disease, according to the Star-line law, the myocardial cells are gradually elongated and fibrotic, the LV cavity is gradually enlarged, part of the damage to the myocardial cells has become irreversible changes, and the LV systolic and diastolic function is reduced, the larger the LVEDd the worse the long-term outcome. For patients with large LVEDd, the perioperative period is critical. All patients are treated with polarizing fluid for 7-14 d before surgery to try to improve cardiac function and create conditions for surgery. Postoperatively, cardiac strengthening, diuretic and vasodilatation were used to improve the nutritional status of patients. Intraoperative myocardial protection is directly related to the occurrence of early postoperative complications and death. Intraoperatively, the aortic block time should be shortened as much as possible, the mitral valve should not be too large to reduce the left ventricular preload, and the replacement of the mitral valve and the aortic valve should be matched, and their difference should be 2~3 models as appropriate. Myocardial protection is achieved by cold blood cis-perfusion + continuous coronary sinus retrograde perfusion. Warm blood perfusion is used before opening the aorta, and its mixture contains mannitol, magnesium ions, arginine, and ATP to reduce the occurrence of postoperative hypocardial arrhythmia. The assisted circulation should be long (1/3 to 1/2 extracorporeal circulation time). Routinely place temporary artificial pacemakers after shutdown to prevent postoperative arrhythmias (bradycardia). Postoperatively, enhance the use of positive inotropic drugs such as dobutamine, dobutamine, epinephrine, isoprenaline and amrinone. Especially the pumping of epinephrine and dobutamine not only raises blood pressure and ensures renal blood supply, but also enhances myocardial contractility and maintains electrolyte and acid-base balance, especially serum potassium, which should be maintained at 4.5~5.0 mmolPL Pay attention to supplementation of magnesium and calcium plasma, which can effectively reduce the occurrence of arrhythmias. For frequent ventricular premature beats, early application of cortisone should be used to reduce arrhythmias, especially frequent ventricular premature and supraventricular tachycardia. The surgical risk for type II of giant heart valve disease is relatively small, while for types I and III, the surgical risk is large and postoperative complications are numerous, and their perioperative management should be emphasized. For small left ventricles, attention should be paid to low cardiac discharge after surgery, and for large left ventricles, attention should be paid to arrhythmias. The choice of surgical indications for giant left ventricles and low EF values is based on the patient’s condition as appropriate. The results of surgery for large heart patients with small left ventricles are encouraging with good long-term results.