Patient: Description of the condition (onset time, main symptoms, hospital visited, etc.): rheumatoid heart disease 30 years ago in Changsha Annex I Hospital had mitral valve dilatation surgery, in 2010 began to appear regular lower extremity water Chung, body water is difficult to drain out of the body, and gas. March 2011 in Jiangxi People’s Hospital had mitral valve balloon dilatation (internal surgery), after surgery, gas but aggravated, what I can’t sleep in any direction, and I can’t exercise, and I need to take diuretic drugs for water in my lower limbs. Symptoms, after mitral balloon dilatation, my gas worsens, I can’t sleep in any direction, and I can’t exercise, my lower limbs are watery, I need to take diuretic drugs, my liver is stagnant, and I am large. Heart color ultrasound examination records: 1, left atrial internal diameter 48mm aortic opening amplitude 18mm, aortic annulus internal diameter 28mm, internal diameter 20mm. 2, right ventricular flow curvature conductance 19mm, left ventricular end-diastolic diameter 42mm, left ventricular end-systolic diameter 31mm, septal thickness 8mm, left ventricular thick wall posterior wall 8mm, right atrial size 79*55mm, left ventricular ejection fraction 58%, left ventricular internal diameter shortening rate 29%, output per beat 35ml, cardiac output 2.6ml. 3, left atrium, right atrium, right ventricle enlarged, septum and posterior wall of left ventricle not thick, ventricular wall amplitude of motion fair, no obvious intermittent abnormalities, mitral valve echogenicity enhanced and thickened. 4, adhesion to open restricted closure poor, mitral valve 1.5 cm2, tricuspid valve poorly closed, remaining membrane fair, left atrium not detected obvious thrombus-like echo. The systolic pressure of the pulmonary artery was estimated to be about 43 mmhg. The right-to-left septum was seen at the atrial level, with an antegrade mitral flow velocity of 1.74 m/s and an antegrade aortic valve velocity of 1 m/s. There was no thrombus on dual-source CT of the lung, and the texture was clear and in good condition. The patient was in good condition. How can I change my gas condition so that the patient can rest well plus suitable exercise and edema condition, can I have tricuspid valve repair surgery, how risky is the surgery, and can the above condition disappear after I do it? Doctor: Edema is mainly caused by right heart failure due to massive tricuspid regurgitation, surgery can replace the mitral valve and repair the tricuspid valve. It is recommended to visit our hospital. Patient: I want to ask if I have to replace the mitral valve? Because in March this year, the patient just underwent a mitral valve dilation, so this surgery is not a waste of time, you still have to replace. The tricuspid valve repair is something we know is necessary. The doctor: The mitral valve itself is still a moderate stenosis, the leaflet itself also has obvious lesions, theoretically sooner or later, surgery to replace the valve. The tricuspid valve lesion will also be there, in the case of severe tricuspid valve insufficiency, would not be suitable for mitral valve expansion, your symptoms are not relieved but worsened, it means that the last surgery was done for nothing. Patient: Do I have to have mitral replacement? Theoretically, tricuspid repair can control regurgitation, mitral is also better than before, it should not be a problem, patients do not want to do replacement, because that surgery is risky, you have to pay attention to maintenance, otherwise it is more dangerous, want to change long ago. I just want you to tell me how helpful it would be for the patient to repair the tricuspid instead of replacing the diaphysis. The patient’s body has always been relatively weak, he absolutely does not agree to do the replacement, he is afraid to collapse on the operating table. The risk of replacing the mitral valve and repairing the tricuspid valve is less than repairing the tricuspid valve alone, because the mitral valve is replaced, the lesion is completely treated, the patient’s heart is completely relieved of the burden and should be on the road to recovery. On the contrary, mitral valve lesions are still present, even if the tricuspid valve is repaired, the results are not good, because tricuspid valve lesions themselves are secondary damage to mitral valve lesions, which are generally relative insufficiencies in closure. The intraoperative and postoperative risks are increased. It’s like a car with 2 broken wheels, and you only deal with one, do you think the car will run properly. So if you don’t treat the mitral valve and simply treat the tricuspid valve, it would go against medical convention, or at least I would refuse to do so.