Recently, our Department of Cardiac Surgery I has successfully completed 4 cases of complex heart valvuloplasty. Based on real-time monitoring by esophageal ultrasound, this type of surgery involves the participation of surgeons, anesthesiologists and ultrasonographers in the surgical decision-making process. For some patients who still have some basic heart valve anatomical structure as confirmed by esophageal ultrasound, traditional valve replacement surgery is avoided, and the anatomical shape of heart valves is restored by means of leaflet, annulus, and tendon cable repairs. In the end, these patients were able to regain normal heart valve function while avoiding the pain of lifelong anticoagulant medication and the complications associated with anticoagulant medication, including bleeding and infarction, etc. The causes of the disease varied among the 4 patients, and the 4 diseases were the most common indications for valvuloplasty. The first patient was 10 years old and had a congenital endocardial cushion defect with anterior mitral valve cleft and posterior valve dysplasia. The 2nd patient was 60 years old and had severe mitral valve closure insufficiency due to degenerative disease causing mitral leaflet prolapse. The 3rd patient was 16 years old and had a perivalvular abscess of the mitral valve with valve perforation due to infective endocarditis. The fourth patient was 22 years old and had severe mitral and tricuspid valve closure insufficiency due to connective tissue disease causing heart valve prolapse and tendon cord rupture. Effective valvuloplasty surgery not only restores the anatomical shape of the heart valves, but more importantly aims to improve and restore the valves as well as the normal functioning of the heart so that the heart can function properly and healthily. Effective valvuloplasty is the best treatment for young, childless women with valves. The American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for the Treatment of Heart Valve Disease recommend that valvuloplasty be performed early in patients with degenerative valve disease, even if they are not yet symptomatic. However, this guideline has not been widely adopted due to the relative complexity of the valvuloplasty procedure and the high level of surgical skill required. Modern ultrasound technology is capable of examining the structure and function of heart valves, and intraoperative transesophageal ultrasound technology provides strong technical support for the development of valvuloplasty surgery, making it a reliable basis for judging valvuloplasty. The mutual collaboration between cardiac surgery, anesthesiology and ultrasound has created a good development platform for cardiac surgery to carry out new technologies in our hospital.