The patient was a 66-year-old male who was admitted to the hospital with the main reason of “shortness of breath after activity for 5 years, inability to lie down and weight loss for 3 months”. The patient had a kidney transplant 9 years ago due to “hypertensive kidney damage” and was taking primaquine, cyclosporine and hormones for long-term anti-rejection treatment. 5 years ago, he started to have symptoms of shortness of breath after exertion, which could be relieved after rest. “The patient came to our emergency room two days ago and was admitted to our department for further treatment. The patient had lost significant weight and weight since the onset of the disease. He had old tuberculosis in both lungs for more than 50 years; his blood pressure was elevated for more than 20 years with a maximum of 220/140 mmHg. Physical examination: T36.2℃, P100 times/min, R20 times/min, blood pressure 110/50mmHg. poor general condition, normal growth, poor nutrition, skin There was no petechiae, no yellowish stain, no abnormalities in the head and organs, no deformity in the thorax, chest breathing existed, no chest wall varices, bilateral respiratory kinetics were consistent, bilateral tactile fibrillation was symmetrical, no enhancement or diminution, no pleural friction was detected, and both lungs were clear on percussion. Scattered wet rales could be heard at the base of both lungs. There was no abnormal elevation in the precordial region, no abnormal pulsation, the apical pulsation was located about 2.0 cm lateral to the left midclavicular line at the 5th intercostal space, the heart border was large on the left, the heart rate was 100 beats/min, diastolic rumble-like murmur and class III systolic blowing murmur could be heard in the mitral valve auscultation area, radiating to the bottom of the heart, diastolic murmur could be heard in the aortic valve auscultation area, and no tremor was palpable. A 20-cm-long surgical scar was visible in the right lower abdomen, the liver and spleen were not palpable, and there was no edema in both lower extremities. A thick arteriovenous fistula was seen in the right wrist and tremor was palpable. Pathological signs were negative. Three blood cultures were free of bacterial growth. The electrocardiogram showed sinus tachycardia, left ventricular high voltage, and ST-T abnormalities in leads I, avL, and V6. Chest radiograph showed enlarged cardiac shadow, increased pulmonary blood, and coarse pulmonary texture. Echocardiography showed widening of the ascending aorta and normal pulmonary artery internal diameter. The left atrium was enlarged, the left ventricular wall was thickened, the mitral valve was gross, thickened, and echogenically enhanced, and strong echogenic masses were seen in the anterior leaflet attached to 0.6×0.3 cm and 0.3×0.3 cm strong echogenic masses, some of which danced with the cardiac cycle, and the remaining valve structure and opening and closing were not significantly abnormal. Multispectral showed severe mitral regurgitation and severe aortic regurgitation. Chest CT showed bilateral pleural effusion and pulmonary inflammation. The patient’s admission diagnosis was 1, subacute infective endocarditis, aortic valve insufficiency (severe), mitral valve insufficiency (severe), large left heart border, sinus rhythm, cardiac function class IV (NYHA classification); 2, right lung infection; 3, hypertensive disease (grade 3, very high risk); 4, post-renal transplantation; 5, old pulmonary tuberculosis. Treatment after admission: Maspine anti-inflammatory, digoxin and tachyphylaxis, active medical treatment, the patient’s condition deteriorated, heart failure symptoms worsened, weight loss continued, the whole body was in a state of failure, 2 weeks after admission, routine blood tests showed Hb63g/L, Bun21.7/L, Two weeks after admission, routine blood tests showed Hb63g/L, Bun21.7/L, TBIL29.0umol/L, DBIL10.5umol/L, chest X-ray showed butterfly shadow in both lung halls and increased lung texture. Surgical treatment: The patient underwent infection lesion removal and mitral + aortic valve replacement on the 20th day of admission, and intraoperatively he was seen to have perforation of the right coronary valve of the aortic valve, formation of leaflet redundancy, and large redundancy of the ventricular surface of the mitral valve, involving the papillary muscle, with excision of the autologous valve and replacement of the biological valve. The operation time was 3h45min, the extracorporeal circulation time was 119 min, and the aortic block was 74 min. the postoperative recovery process was smooth, the postoperative application of vancomycin + sulphen anti-infection, the valve tissue bacteriology returned as Enterococcus faecalis, sensitive to vancomycin, continued antimicrobial therapy, postoperative The postoperative blood culture was negative, the ultrasound showed good biological valve function and normal renal function, and he was discharged after 5 weeks of antimicrobial application. Commentary: With the advancement of medical technology, the number of patients surviving long term after organ transplantation is gradually increasing and these patients are prone to infectious complications due to the need for long term immunosuppressive drugs. Abbott KC has conducted a study of 33 patients who underwent renal transplantation between January 1, 1994 and June 3, 1997. A retrospective study of 33,479 patients who underwent renal transplantation between January 1, 199 4 and June 3, 1997 showed that the incidence of infective endocarditis within 3 years after renal transplantation was 7.84%, with risk factors associated with valvular disease, graft function The risk factors were associated with valve disease, loss of graft function, and prolonged pre-transplant dialysis time. Ireland JH summarized the incidence of infective endocarditis in dialysis patients and renal transplant patients, and the risk of infection in these two groups was 3.0-100 times higher than in the general population. 0-100-fold, with a 1-year mortality rate of 40- The main causative organisms were Gram-positive cocci, 60%-80% were Staphylococcus aureus, 1 0-20% for coagulase-negative staphylococci, fungal endocarditis can occur in renal transplant patients, but mainly occurs within 3 months after transplantation, these patients in addition to blood culture, transesophageal ultrasound is the most effective means of examination, and antimicrobial therapy in the absence of bacteriologic evidence should cover the most common pathogens and take into account methicillin- and vancomycin-resistant strains. Treatment should remove the infected lesion and continue with antimicrobial agents for 4-6 weeks. The clinical outcome of infective endocarditis after renal transplantation has been reported rarely, 14 cases of such disease were reported in the literature before 1999, and conservative treatment was mostly chosen in the treatment, with poor results and mortality rate of 50%. haddad SH 2004 reported 3 cases of nosocomial infection in 3 in-hospital critically ill patients, 2 of which were treated surgically, 1 survived, 1 surgical patient and 1 non-operative patient died. The attitude towards surgery in normal population presenting with infective endocarditis is more aggressive, but there is no consistent treatment plan for post-organ transplant patients presenting with infective endocarditis, which is mostly treated conservatively due to long-term immunosuppressive drugs, impaired immune function, poor systemic condition and poor surgical tolerance in such patients. According to the observation of Dresler C et al, the mortality and morbidity and mortality rates of patients with happy surgery after renal transplantation, although increased, are at an acceptable level, and most patients’ transplanted organs can reach the preoperative level. Combined with our experience with this patient, we believe that post-transplant patients with underlying cardiac pathology are susceptible to infective endocarditis, and that the clinical presentation of such patients is not as typical as it could be, with symptoms easily masked by the primary condition. If endocarditis is a major life-threatening factor, aggressive surgical treatment is indicated, as it is the only means to ensure patient survival. Perioperative anti-rejection drugs can still be taken normally to ensure the function of the transplanted organ under the premise of ensuring cardiac function in order to maximize the patient’s quality of life. The initial results of surgical treatment in this patient were satisfactory, and the long-term results are to be observed.