Abstract
As the long term results of the lateral tunnel Fontan procedure, as well the extracardiac Fontan procedure, continue to improve, the threshold for shifting to a single ventricle track in the setting of a complex and non-ideal biventricular repair alternative has been lowered. Two ventricle options that subject the child and family to multiple surgical procedures and lengthy hospitalizations, as well a limited cardiac output because of ventricular hypoplasia or AV valve hypoplasia, should be avoided. This article will review the complex decision making that is required in the gray area between a clear biventricular pathway and the single ventricle track for patients with two ventricles.
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