Fontan or septation: when I abandon septation in complex lesions with two ventricles

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.