It is important to be vigilant and clear about the presence or absence of coronary artery disease when doing heart valve replacement surgery, otherwise the consequences are unimaginable! Some time ago, the Department of Cardiac Surgery admitted a 65-year-old patient with rheumatic heart disease. The patient had been suffering from panic and shortness of breath after activity for 2 years, with no typical history of angina pectoris, and the electrocardiogram had no clear features of myocardial ischemia. Valve replacement surgery is a major operation in cardiac surgery, and the patient’s age, therefore, we carried out a comprehensive examination and active preoperative preparation for the patient, such as cardiac function of the cardiovascular system, electrocardiogram, color ultrasound, pulmonary function of the respiratory system, chest radiographs, renal function of the urinary system, the endocrine system for diabetes mellitus, the blood system for coagulation dysfunction, and rheumatism, etc. We carried out a detailed examination and active preoperative treatment. The patient had no history of angina pectoris. Since the patient had no history of angina pectoris and the electrocardiogram showed no signs of coronary artery disease, the possibility of combined coronary artery disease was considered to be extremely small, and coronary angiography was also associated with a certain degree of risk. It was proposed to perform only valve replacement surgery, but before the operation, considering the patient’s age and the high standard of living of urban residents, we were still not assured that, in line with the attitude of seriousness and responsibility to the patient, we still implemented coronary arteriography on the patient. The real do not make do not know, a make a shock. The patient not only had coronary artery disease, but also multi-branch lesions, the left coronary artery anterior descending branch, the left rotary branch and the diagonal branch has 50% – 90% stenosis. We then performed a valve replacement plus bypass surgery for the patient, the effect of the surgery is very ideal, thus saving the patient’s life, otherwise the consequences are unimaginable. In the heart valve replacement surgery, due to valve disease combined with coronary heart disease is still relatively rare, valve replacement and coronary artery bypass grafting hand just carried out in recent years, and can carry out this type of surgery of the hospital is not much, therefore, both doctors and patients of valve disease whether combined with coronary heart disease did not attract enough attention. With the progress of society, the improvement of people’s living standard and the intensification of social competition, the incidence of coronary heart disease is getting higher and higher. Not only rheumatic heart valve disease or degenerative heart valve disease can be combined with coronary heart disease, but also coronary heart disease itself can cause heart valve disease. Therefore, we suggest that coronary angiography should be performed in the following patients: 1) age greater than 50 years; 2) history of angina pectoris; 3) electrocardiogram with myocardial ischemia. For patients with valvular disease combined with coronary artery disease, once the diagnosis is confirmed, it will be performed at the same time with valve replacement and bypass surgery, although these patients often have serious conditions, surgical difficulties, surgical complications, but as long as the preoperative diagnosis is clear, well-prepared, fast and perfect surgical operation and strengthen postoperative monitoring, it is still possible to achieve good surgical results. Our hospital has implemented 10 cases of this type of difficult surgery, all achieved more satisfactory results. Valve replacement and bypass surgery is the only effective treatment for valvular disease combined with coronary artery disease. If the diagnosis of coronary artery disease is missed and only valve replacement surgery is performed, the result of the surgery is often a lack of talent, with a very high mortality rate, and even in the unlikely event that the patient survives, his or her cardiac function and quality of life are also very unsatisfactory.