Severe tetralogy of Fallot, pulmonary atresia with ventricular septal defect and double outlet of the right ventricle are severe and complex precordial diseases with a high mortality rate for surgical correction. In the past 5 years, we have applied the bovine jugular vein valve in the correction of these severe patients with good results, which are reported as follows: I. Clinical data and methods From January 1, 2007 to May 20, 2013, a total of 28 patients with severe complex precordial disease were operated with the bovine jugular vein and its valve prepared by Beijing Birenshi, 13 males and 15 females, aged 1.2 to 23 years. The average age was 3.6 years ± 1.56 years. There were 15 cases of severe tetralogy of Fallot, 5 cases of pulmonary artery atresia with ventricular septal defect, and 8 cases of double outlet right ventricle. All patients were diagnosed preoperatively by echocardiography and 64-row CT. Nakata index (pulmonary artery index) was 151±8.91 mm2/M2; LVEDVI (left ventricular end-diastolic volume index) was 28±1.05 ml/M2; the pulmonary artery and annulus were severely stenosed in patients with tetralogy of Fallot and right ventricular double outlet. There were three cases of pulmonary atresia type I and two cases of type II. During the operation, the right ventricular outflow tract was firstly incised, the abnormal wall bundle and septal bundle were excised to unblock the right ventricular outflow tract, while the septal defect was repaired afterwards; for the right ventricular double outlet, an artificial vessel piece was used to establish an internal tunnel. Finally, a 14-, 15-, or 16-gauge bovine jugular vein with valve tube was selected according to the patient’s weight size and applied after flushing with sterile saline. The valve is cut longitudinally along the valve junction and trimmed into an oblong patch with a single leaflet, about 3 cm above and below the annulus, and the leaflet is positioned well corresponding to the autologous pulmonary valve and sutured with 5-0 Prolene continuously around the entire circumference to widen the right ventricular outflow tract and pulmonary artery. For type II pulmonary atresia, the appropriate length is measured first, and the valve is placed in the middle position with the pulmonary artery and the right ventricular outflow tract connected at each end. After exclusion of left heart gas, the aortic block clamp was opened. II. RESULTS Twenty-seven of the 28 patients recovered smoothly and were discharged from the hospital cured, while one 1.2-year-old patient with double outlet of the right ventricle had a postoperative complication of low cardiac output syndrome and died on the second day after surgery. The mortality rate was 3.5%. In the remaining 27 patients, pulmonary artery flow velocity of 2.12±0.15 m/s was detected by echocardiographic follow-up examination after 3 months to 6 years and 3 months of outpatient follow-up. Only three patients had a small amount of pulmonary regurgitation, and the heart structure and function recovered well. The patients all resumed normal life. There were 23 cases with class I cardiac function and 4 cases with class II. 3. Discussion 1. Severe tetralogy of Fallot, pulmonary atresia with ventricular septal defect and double outlet of the right ventricle are severe and complicated precardiac diseases, and the mortality rate of surgical correction is high. The postoperative complication of hypoventilation syndrome makes it an important cause of mortality. Residual stenosis of the right ventricular outflow tract and pulmonary artery or/and pulmonary valve closure insufficiency is one of the causes of postoperative hypoventilation syndrome. Especially when there are many intrapulmonary body pulmonary collateral vessels, the postoperative pulmonary circulation blood volume is significantly more than normal, and if the pulmonary valve annulus is not widened with materials with valves at this time, then the regurgitant flow of the pulmonary valve during diastole will increase and subsequently lead to right ventricular insufficiency. 2, In the past, we often use the autologous pericardium or bovine pericardium to sew a single valve intraoperatively to prevent regurgitation of the pulmonary valve, and its recent effect can also be. In terms of anatomical structure, the bovine jugular valve is better, because it is very close to the human pulmonary valve, its leaflet is extremely thin, translucent, its surface is covered with a layer of endothelial cells, the inner layer of the stent is a continuation of the middle layer of the vessel wall, the inner membrane is smooth, the resistance to blood flow is small, and the closing effect is good. 3, Intraoperative application should pay special attention to make sure that the valve leaflet corresponds well with the patient’s pulmonary valve to avoid its prolapse and affect the therapeutic effect. 4, According to our follow-up, the longest application time has been 6.5 years, and no stiffness or calcification of the valve leaflets, no pulmonary regurgitation, and no other adverse effects have been observed. Of course, the long-term results need to be observed in further close follow-up. There are reports of stenosis in the distal anastomosis of the bovine jugular vein with valve in the long term follow-up, but we did not see any right ventricular outflow tract stenosis in our follow-up.