1.Concept: Cardia bradycardia is a primary dysmotility disorder of the esophagus, characterized by hypertonicity of the lower esophageal sphincter (LES), which fails to relax completely during feeding and stops peristalsis of the esophageal body, leading to esophageal obstruction. 2, Etiology: Cardia dyskinesia is one of the neurogenic diseases, which is a dysfunction of the esophageal neuromuscular, resulting in the cardia (or lower esophageal) sphincter can not work normally. The cardia sphincter is located between the esophagus and the stomach, and plays the role of “barrier” in the human body, i.e., when people swallow food, it opens in time to allow food to enter the stomach from the esophagus; and closes in time to prevent the food in the stomach from returning back to the esophagus when the swallowing of food is completed. Yang Guangyu, Department of Thoracic Surgery, Henan Provincial People’s Hospital A patient with cardia failure retardation has a dysfunction of the esophageal neuromuscular function, and the cardia sphincter cannot work normally. The cardia sphincter cannot open completely when swallowed food reaches the cardia (i.e., retardation malpractice), resulting in food not being able to pass through the cardia smoothly and dysphagia. Or the cardia sphincter cannot close in time after the esophagus transports the food and there is a reflux of food from the stomach back into the esophagus, resulting in vomiting and pain. Long-term obstruction of the lower esophagus leads to thickening of the muscularis propria, adhesion of the esophageal mucosa to the muscularis propria due to inflammation, and dilatation of the upper esophagus. The main purpose of the treatment of cardia retardation is to restore the cardia sphincter’s role as a “barrier”, and the main treatment is Heller’s surgery – myotomy of the cardia in the lower esophagus, and stripping of the muscle layer from the mucosa. (1) Barium meal imaging: the lower esophagus is mildly dilated, and the lower esophageal sphincter cannot be relaxed, showing a “beak-like” change. (2) Gastroscopy: the lumen of lower esophagus is spacious, the mucous membrane is edematous and thickened with different degrees of inflammatory changes, and the cardia is narrow. (1) Conservative treatment, dilatation therapy, botulinum toxin sphincter injection and so on, but the effect is not ideal. (2) Surgical treatment: Heller’s operation – lower esophageal cardia myotomy. 5. Surgical points (details): (1) Fully empty the stomach with a large gastric tube before surgery. (2) The incision in the gastric wall should not be too long, down to the transverse gastric vein is appropriate. (3) The incision in the lower esophagus should not be too short, which may lead to incomplete myotomy; 6-8 cm is appropriate. (4) The length of the fundus incision is less than 1 cm. (5) The myotomy of the lower esophagus should be about 50% of its circumference. Heller’s operation: Heller’s operation is less traumatic, only need to incise the lower esophageal cardia muscle layer length 6-8cm and strip the adhesion between the muscle layer and the mucosa, but to loosen the muscle layer to reach 50% of its circumference. If the mylohyoid layer is not completely incised, the symptoms of dysphagia cannot be effectively relieved and are prone to recurrence. Severe pancreatic dysphagia is due to the severe adhesion of the lower esophageal muscularis layer to the mucosal layer (as shown in the figure), and such patients are also associated with heavy thickening of the muscularis layer. It is not easy to completely incise the muscle layer intraoperatively, and it is easy to cause mucosal rupture or different thickness of mucosa when peeling off the muscle layer from the mucosal layer, which is one of the reasons why mucosal tearing is easy to occur in the postoperative period. This is one of the reasons why mucosal tears may occur in the postoperative period. In this case, attention should be paid to postoperative gastrointestinal decompression. Generally speaking, postoperative patients have nasogastric tube decompression, if the tube is ineffective, no drop of digestive fluid is drained out for several hours or even 1 day after surgery, this situation is very dangerous if ignored. Once the patient experiences nausea and vomiting, the enormous pressure of the gastric contents is enough to rupture the cardia mucosa. We have also had lessons in this regard.