(A) Valve lesions and their effects Between the atria and the ventricles, and between the ventricles and the aorta, there is a valve-like structure called a heart valve. We often compare valves to the doors of a house. These “doors” also have a frame, a door, and in some cases a lasso, but they are much more delicate. The “doors” on the heart will open very smoothly, blood flow will be unimpeded through these doors; when they close, they will close very tightly, can not let the blood flow back through the backflow. But these “doors” are used for a long time, and under the action of various factors, they will become diseased, called valve disease. There are two types of valve disease: stenosis, which means that these “doors” do not open completely when they are open, and blood does not flow smoothly through them; and regurgitation, which means that these “doors” do not close completely when they are closed, and blood flows back the way it came. In valve stenosis, the heart has to use more and more force to get blood through the narrowed valve, and in regurgitation, the heart has to prepare more blood before each contraction to counteract the effects of the regurgitation. Therefore, the end result of either valve stenosis or valve regurgitation is that the heart has to do more work, and in the long run, the heart cannot take on the overload and the patient will show signs of heart failure. (ii) Valve repair Severe valve lesions require surgical treatment. Drug treatment can only temporarily relieve the symptoms and cannot solve the underlying problem. There are two types of surgical treatment: repair and replacement. Repair is to repair the bad “door” and use it again, “door” is still its own “door”. Replacement is to remove the original “door” and replace it with a new artificial “door”. It should be said that valve repair is the most ideal treatment. This is because the repair preserves the valve itself, the mitral and tricuspid valves, and the appendage structures of the valve, which is very beneficial in preserving the damaged heart function, especially in those patients with severely impaired heart function. In fact, the greatest benefit of valve repair is that a repaired valve does not require lifelong anticoagulation, does not require regular monitoring of coagulation, and has a better quality of life than valve replacement. Therefore, for a valve that can be repaired, try to repair him rather than replace it. (iii) Biological versus mechanical valves Although valve repair is much better than valve replacement. However, there are always some valves that are not suitable for repair. Then, these valves that are not suitable for repair will eventually need to be replaced. There are two main types of valves used in valve replacement, a mechanical valve and a biological valve. Mechanical valves can be thought of as not being bad for decades, but mechanical valves have the risk of localized thrombosis, so mechanical valves have to be replaced with a lifetime of anticoagulants, which don’t work if used sparingly, but can cause bleeding if used more often. Anticoagulation for 3-6 months after biologic valve surgery is sufficient, however, there is postoperative destruction of the biologic valve, and it is generally believed that the biologic valve will break down in 10-15 years and require reoperation. Therefore, it is generally the elderly who choose bioprosthetic valves. Of course, with advances in technology, the service life of biologic valves is improving, but they are still not as well tolerated as mechanical valves. (iv) Repair or Replacement Each patient is an individual and the best treatment is determined by his own anatomic conditions. In addition, different surgeons may have preferences and should discuss and consult with their own surgeon to develop the most appropriate treatment for them.