There have been multiple modifications for surgical palliation of functional single ventricle since the initial report by Fontan and Baudet in 1971. A modified Fontan procedure has been offered to patients with a variety of complex cyanotic heart disease at younger ages, and has resulted in decreased mortality. Reducing morbidity continues to be a challenge. These issues are multiple and include effusions, arrhythmia, ventricular function, exercise ability, progressive cyanosis from pulmonary arteriovenous malformations, systemic to hepatic venovenous malformations or atrial level shunting, thromboembolism, and protein-losing enteropathy. This article reviews clinical contributions published in the past year.