1, the definition of some precordial disease although there are two sets of atrioventricular valves, two ventricular chambers, but the right ventricle dysplasia or poor function, can not bear all the cardiac output, so in the anatomical correction surgery at the same time for two-way Glenn surgery, in order to reduce the right ventricular load, improve the surgical effect. This operation is also called partial biventricular repair, or pulsatile cavopulmonary anastomosis assisted biventricular repair, the body circulation blood is completely pumped by the left ventricle, and the pulmonary circulation blood flow comes partly from the superior chamber blood flow via bidirectional Glenn shunt and partly via the dysplastic right ventricle – pulmonary artery blood flow. 2. Advantages of this procedure (1) Equal flow in the body-pulmonary circulation. (2) Bidirectional Glenn shunt reduces right ventricular volume load and improves right ventricular function, while reducing the adverse effects of right ventricular distension on the left heart. (3) Improved tricuspid regurgitation. (4) Increased pulmonary blood flow compared to simple bidirectional Glenn shunt, because of the inflow and pulsatility of the inferior cavity, and can reduce or even eliminate bidirectional Glenn shunt distal complications, such as progressive hypoxemia and secondary pulmonary vasculopathy. (1) Intracardiac repair + bidirectional Glenn shunt (2) Intracardiac repair + classical Glenn shunt (3) Intracardiac repair + bidirectional Glenn shunt + anastomosis between the proximal superior vena cava and the right pulmonary artery (4) Intracardiac repair (preserving ASD) + bidirectional Glenn shunt (4) Indications for surgery (1) Right ventricular structural dysplasia or poor function. (1) The right ventricle is structurally dysplastic or functionally poor, but postoperative right ventricular insufficiency can be easily avoided by performing 11/2 ventricular repair. If the septum is intact and pulmonary atresia is operated on, biventricular repair cannot be performed if the tricuspid valve Z value (Z value = tricuspid annulus diameter measurement – normal value/standard deviation from normal mean) is too negative. According to studies, only 50% of biventricular repairs are feasible with a Z value of -2 and only 30% with -3. Therefore, these patients may be the best beneficiaries for 11/2 ventricular surgery. Of course, factors affecting the outcome of 11/2 ventricular surgery include right ventricular compliance, tricuspid regurgitation, right ventricular outflow tract pulmonary artery dysplasia, and pulmonary vascular resistance in addition to the Z value of the tricuspid valve. The lowest 11/2 ventricular repair limit is (The judgment of right ventricular insufficiency is mainly based on the enlargement of the heart and the increase of central venous pressure. When the obstruction of the right ventricular outflow tract is excluded in some patients after biventricular correction, and the central venous pressure continues to rise or the heart is more than 120% larger than normal, it often indicates right ventricular insufficiency and the operation needs to be changed to 11/2 ventricular correction. For Ebstein malformation right ventricular moderate enlargement or severe depression of cardiac function for 11/2 ventricular repair indications, special biventricular repair UCG shows tricuspid valve and right ventricular dysfunction, or right atrial pressure is greater than 12 mmHg, or right atrium is more than two times the left atrium can be additional bidirectional Glenn shunt. (2) Patients who have undergone a bidirectional Glenn shunt for single ventricle surgery are converted to 11/2 ventricle repair. These patients are not suitable for biventricular repair but the intracardiac structure allows surgical separation of the ventricles, such as small right ventricle, right ventricular inflow tract ventricular defect, tricuspid valve span; or D-TGA cone septal defect tricuspid valve and small right ventricle, such patients can avoid Fontan surgery if they undergo palliative surgery in the neonatal period followed by bidirectional Glenn bypass, such as 11/2 ventricular surgery. The Fontan procedure can be avoided if 11/2 ventricular surgery is performed. 5. Surgical results and complications (1) In patients with right ventricular structural dysplasia, the results of intracardiac repair + bidirectional Glenn surgery are satisfactory. The lowest Z value was -10 and there were no surgical deaths. In the postoperative hemodynamic study, there was reverse flow in the superior vena cava during systole, which disappeared 6 weeks postoperatively, which was associated with improved left ventricular compliance and reduced pulmonary vascular resistance. distant cardiac catheterization revealed distribution of respiratory-dependent superior vena cava flow to the right pulmonary artery and proximal left pulmonary artery during diastole and right ventricular pulsatile flow to the left and right arteries during systole, which confirmed the ability of the small but available right ventricle to provide bilateral pulmonary artery Miyagi performed intracardiac repair with classical Glenn procedure in 3 patients with pulmonary atresia with intact septum with Z values of -6.5 to -5.2 and right ventricular end-diastolic volumes in the range of 30.3% to 37.4 of normal, with satisfactory postoperative ultrasound follow-up at 10 years. Gentles summarized 8 patients with pulmonary atresia with intact septum with Z values of -4.1 to -2.0 and right ventricular volumes <25% of left ventricular volumes who underwent endocardial repair plus cavity transection with both dissections anastomosing to the right pulmonary artery. Only one case had mild limitation of activity at midterm follow-up. (2) In patients with moderate to severe Ebstein's anomaly, 11/2 ventricular surgery has also yielded good results. 9 cases were reported by Marianeschi using intracardiac repair with bidirectional Glenn shunts, with no operative deaths and all with class I cardiac function at 2-year postoperative follow-up, but 11/2 ventricular repair is less effective in the treatment of acute right heart failure. (3) Reddy performed double Switch surgery for patients with corrected transposition of the great arteries and arterial Switch surgery for combined transposition of the great arteries with right heart hypoplasia and tricuspid valve ride on the basis of the previous bidirectional Glenn shunt successfully. (4) Major complications: Early stage is superior vena cava obstruction syndrome with increased and pulsatile superior vena cava pressure, which may lead to superior vena cava-like dilatation, increased celiac fluid and pleural effusion. Treatment: (1) Circumferential constriction of the right superior pulmonary artery between the main pulmonary artery and the cavopulmonary anastomosis. (2) Conversion to single ventricle surgery. Patients with 11/2 ventricular repair with classic Glenn shunts may develop a pulmonary vein fistula in the long term. The 11/2 ventricular procedure is a new surgical procedure that has been developed in recent years as an alternative to biventricular repair in children who have failed biventricular repair and as a conversion procedure in children who are not candidates for biventricular repair and who have avoided the Fontan procedure. This procedure is safe and reliable, with satisfactory long-term and medium-term results. However, there is a lack of appropriate studies and evaluation of the structural function of the right ventricle. There are still no definitive criteria for choosing biventricular or 11/2 ventricular repair. In addition, further controlled studies with large samples are needed to determine whether 11/2 ventricular surgery is truly superior to Fontan surgery or biventricular repair in individual children.