No area of congenital heart disease has undergone greater change and innovation than single ventricle management over the past 20 years. Surgical and catheterisation laboratory interventions have transformed outcomes such that in some subgroups more than 80% of the patients can survive into adulthood. Driven by parallel development in diagnostic imaging and cardiac intensive care, surgical management is focused on the neonatal period as the key time to creating a balanced circulation and limiting pulmonary blood flow. Different configurations of the circulation, including new types of surgical shunts, and the role of "hybrid" circulations provide greater options and better physiology. This overview focuses on these changes in surgical management and timing, but also looks at the exciting areas of regenerative therapies to improve ventricular function, and the concept of ventricular rehabilitation to achieve biventricular circulations in certain groups of patients. The importance of early (neonatal) intervention and multidisciplinary approach to management is emphasised, as well as looking beyond simply survival to also improving neurodevelopmental outcomes.
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