”Crossed hearts” are a group of complex congenital cardiac anomalies characterized by a spatial crossover of the body and pulmonary venous flow axes at the atrioventricular level, forming a cross in the cardiac plane, and often accompanied by abnormalities in the atrioventricular junction or ventricular aortic junction and other intracardiac malformations. According to the literature, the vast majority of crossed atrial viscera are orthotropic, with only a few inversions. The atrioventricular connections are more coordinated and less discordant. That is, the morphologic right atrium is more often connected to the morphologic right ventricle, although the latter is left-sided in spatial position. Abnormalities of the ventricular aortic connections are particularly common, with the vast majority of cases associated with transposition, ectasia, or double outlet connections of the aorta. It is extremely rare that all three segments of the atrioventricular great artery connections are normal. The most common pathologic pattern of crossed hearts is a left-sided heart with orthogonal atrial viscera, coordinated atrioventricular connections (right-sided morphologic right atrium connected to the upper left morphologic right ventricle and left-sided morphologic left atrium connected to the lower right morphologic left ventricle), and juxtaposition of the two great arteries (left-sided ascending aorta from the morphologic right ventricle and right-sided pulmonary artery from the morphologic left ventricle). This pathological change, which resembles a corrected transposition of the great arteries in appearance, accounts for more than 2/3 of all cases of crossed hearts. In addition, crossed hearts with double right ventricular outlets based on the aforementioned atrioventricular connections and positions are not uncommon. Intraoperative electrophysiological markers show that the atrioventricular conduction bundle mostly travels on the posterior inferior border of the ventricular defect. Only a few imaging and morphologic studies of the coronary arteries have been performed to date, and the pattern of lesions remains unclear. The most common cross-over heart is the one in which the right and left ventricles are located in the upper left and lower right, respectively. The left ventricle is mainly supplied by the right coronary artery, and its main trunk originates from the right coronary sinus and divides into anterior descending and spiral branches. The former travels along the interventricular sulcus in a subhorizontal direction, while the latter travels along the atrioventricular sulcus to the right and wraps around to the posterior part of the heart. The crossed heart should be distinguished from the upper and lower heart, the difference being that the latter does not cross the body and pulmonary venous blood flow within the heart from side to side. Because of the complexity of crossed heart malformation is difficult to correct, at present, various types of palliative surgery are used more often, and the choice of various procedures is basically the same as other complex precordial palliative surgery. For cases with pulmonary stenosis, body-pulmonary bypass, bidirectional Glenn and modified Fontan type palliative surgery can be chosen; for patients with congestive heart failure with massive left-to-right shunts, pulmonary artery circumferential reduction can be chosen. Crossed hearts are mostly combined with complex cardiac anomalies, which make surgical correction more difficult. Together with the uncertainty of conduction bundle and coronary distribution, as well as the influence of septal position changes on surgery, biventricular correction surgery for crossed hearts is more difficult.