In the modern era, it is possible to achieve programmatic balance in the approach to the treatment of hypoplastic left heart syndrome by offering staged palliation, transplantation, and in suitable cases, biventricular repair. Strategies for optimal selection should continue to improve and evolve. Overall, the current hope for survival, and excellent quality of life, for patients with hypoplastic left heart syndrome and other forms of functionally univentricular heart is better than ever before. Pioneering efforts allowed what we achieve today. Our challenge is to continue to improve the surgical and medical care of these patients towards normalization of survival and quality of life for future generations. These goals will be achieved by capitalizing on current advances in the field, and continuing to "push the envelope", with research into new advances.