The Fontan operation is one of the most common cardiac operations for children with congenital heart disease beyond the first year of age. Although the surgical mortality of this procedure has improved over the past 2 decades, the neurologic outcome in this population is not well described. We performed a retrospective review of 645 patients who underwent the Fontan procedure at Children's Hospital in Boston over the 15-year period between August, 1978 and July, 1993, to describe the incidence of postoperative cerebrovascular accidents or strokes among survivors. We identified 17 patients (2.6%) who suffered a stroke following the Fontan operation. The risk period for stroke in our population extended from the first postoperative day to 32 months after the Fontan procedure. The pre-, intra-, and postoperative clinical features of these patients are described.