One patient with hypoplastic left heart syndrome and another with aortic atresia and a complex form of functional single ventricle, who were candidates for the Norwood operation, received a new palliative procedure. This involved anastomosis of the dome of the pulmonary artery to the undersurface of the transverse arch of the aorta with placement of a fenestrated patch in the main pulmonary artery to divide the systemic and pulmonary circulations. Both patients have survived this initial procedure and will receive second stage palliation at 6 months of age. Shorter circulatory arrest and cardiopulmonary bypass times are required, and this procedure may be a safer alternative than the Norwood for neonates with hypoplastic left heart syndrome and aortic atresia.