Surgical management of the single ventricle

The vast majority of neonates with single ventricle physiology require some form of surgical intervention to realize long term survival. Surgical options are limited as septation of the single ventricle has been described but is an option available for only a small subset of patients with ideal anatomy [1]. Orthotopic cardiac transplant is another approach which because of limited organ availability eliminates many potential candidates by attrition on the waiting list [2]. The most common approach to palliation in the infant with single ventricle is to intervene surgically in a manner that ultimately culminates in an effective, successful Fontan [3]. This typically requires a staged approach of successive operations which optimally preserve pulmonary vasculature and ventricular function while providing a milieu of adequate oxygenation to allow for normal growth and development of the infant.