Objective:To evaluate the surgical efficacy of valve replacement for severe paravalvular leakage(PVL) by echocardiogram. Methods: From June 2000 to December 2007, 26 patients with severe PVL were admittted to our hospital. The patients included 19 males and 7 females, with a mean age of 48 years (ranging 33 to 68 years). Severe PVL was reported in 11 cases after aortic valve replacement and 15 mitral valve replacement. The grades of cardiac function was in NYHA Ⅲ(16 cases) and Ⅳ(10 cases). Preoperation echocardiogram combined with intraoperation findings was the main diagnosis approach. Nineteen patients (73.1%) underwent a second valve replacement (RO group) and 7 (26.9%) were managed conservatively (MC group). Results: One patient died of MODS early after operation in the RO group. During 2 months to 8 years follow-up (mean 2.7 years), one patient had recurrence of paravalvular leakage 2 months later and died of heart failure 5 months later after refusing a second operation. In MC group, one patient died of multiple organ failure in hospital; the rest died within 6 months after operation. Conclusion: Surgical treatment for patients with echocardiogram-diagnosed severe PVL should be performed as early as possible. The mortality and morbidity of conservative therapy are extremely high. Re-operation can greatly improve the long-term survival of the patient and the heart function.