If a normal heart valve is invaded by rheumatic fever or bacteria, resulting in deformation, thickening, adhesion, or even calcification of the valve leaflets and serious adhesion of the subvalvular structures, or if the valve leaflets are poorly aligned or prolapsed, or if the tendon cords are too long or broken causing incomplete closure, so that the valve cannot function as a one-way valve to maintain one-way blood flow, the original valve needs to be removed and replaced with an artificial valve under extracorporeal circulation to restore its physiological function and improve the patient’s quality of life. improve the patient’s quality of survival. For those with good valve quality, no obvious calcification and incomplete closure, valvuloplasty can be used for treatment. A. The following issues should be noted before deciding to operate 1. rheumatic activity Preoperative routine examination of anti-streptococcal hemolysin (ASO), normal should be less than 1:400; blood sedimentation, erythrocyte sedimentation rate (ER), normal male less than 15mm/hour, female less than 20mm/hour. ASO and ER is not normal, indicating rheumatic activity, should be anti-rheumatic treatment, to be improved before surgery, otherwise due to The presence of inflammation in the heart increases the risk of surgery, and the rheumatic activity will increase after surgery. 2, the heart function should be adjusted before surgery, so that it is in the best condition before surgery, the risk of surgery when the heart function is incomplete obviously increases. However, those with severe cardiac insufficiency that cannot be controlled by internal medicine should consider surgery to correct it as soon as possible. 3, age The best age for valve surgery is 20 to 50 years old, too young, because of postoperative rheumatic activity, easy to recur after surgery; too old, easy to combine coronary heart disease and other organ disease, the risk of surgery increases. Second, surgical indications 1, mitral valve replacement surgery indications Once the diagnosis is clear, especially with interstitial pulmonary edema and nocturnal paroxysmal dyspnea, cardiac function below grade II, valve leaflet calcification or subvalvular device lesions are serious, or combined with incomplete closure, as well as re-operation should be considered for valve replacement surgery. If combined with coronary artery disease, severe pulmonary hypertension can also be treated surgically. 2, aortic valve replacement surgery indications Severe aortic valve lesions can no longer be treated with shaping surgery, such as degenerative changes caused by a highly dilated annulus, leaflet tear, and rheumatic heart disease caused by significant leaflet curl, deformation, or even calcification. Left heart failure and infective endocarditis are not absolute contraindications, but the risk of surgery for left heart failure and infective endocarditis that cannot be controlled by medical therapy is significantly increased. 3, tricuspid valve replacement surgery indications Severe tricuspid valve lesions where medical treatment is ineffective, and it is no longer possible to perform shaping treatment or severe tricuspid valve subluxation need to perform valve replacement surgery. For patients with mitral stenosis, if they are young, have class II to III cardiac function (NYHA), no significant valve calcification or insufficiency, no significant leaflet contracture, and no history of left atrial thrombosis or infarction, closed mitral dilatation or direct mitral valvuloplasty can be performed under general anesthesia. The decision whether valvular surgery is better for valvuloplasty or closed dilatation or valve replacement depends primarily on the condition of the patient’s valve itself, taking into account the need for reoperation for valvuloplasty or closed dilatation. For those with significant valve calcification, this is an absolute indication for valve replacement surgery. In younger patients, valve replacement should be considered because of the susceptibility to rheumatic activity and the definite need for reoperation as well as economic issues. For those over 45 years of age with well-controlled rheumatic activity, valvuloplasty can be considered, which allows for longer maintenance of the valvuloplasty procedure. For elderly patients over 60 years of age, replacement of the bioprosthetic valve can be considered, which can avoid various complications caused by anticoagulation.