The use of palliative procedures in the treatment of infants with congenital heart disease has been an established and accepted form of therapy. With progression toward more corrective operations in the first year of life, the more recent use of palliative procedures is examined. Five hundred two infants underwent cardiac operation in the first year of life at the University of California, San Francisco, during the period from Jan. 1, 1975, through June 1, 1979. Four hundred twenty-three (84.3%) underwent “corrective” procedures. One hundred forty-seven of them had tetraology of Fallot, ventricular septal defect (VSD). transposition of the great arteries (TGA), and truncus arteriosus types I and II. These patients, commonly treated in the past with conventional means of palliation, underwent either “correction” or an outflow patch procedure. The operative survival rate was 91%. During the same period, only 26 (5.2%) conventional palliative procedures were performed. Pulmonary artery banding was performed in 13, closed atrial septectomy in two, Blalock-Taussig shunt in five, and Waterston shunt in six. An additional 53 (10.4%) unconventional palliations were performed. Lesions palliated by conventional or unconventional procedures included the complex malformations of pulmonary, tricuspid, and mitral atresia, single ventricle, endocardial cushion defect, TGA with VSD, Taussig-Bing deformity, and Ebstein’s anomaly. These data demonstrate the changing role for the palliative procedure in the treatment of infants with congenital heart disease. Selection of the proper palliative procedure for the complex lesions not amenable to early correction should be predicated on both the nature of the lesion and the factors which influence the ultimate surgical repair, the most important of which is induction of symmetrical growth and development.