Closed heart surgery in congenital heart disease can be palliative or corrective. Palliative surgery aims at improving the physiologic deficit rather than the anatomic defect of the heart. Palliative procedures aim to increase pulmonary blood flow in cyanotic children with decreased pulmonary blood flow (Blalock-Taussig shunt), decrease pulmonary blood flow when there is unrestricted flow (pulmonary artery banding), or improve venous mixing in cyanotic children that require pulmonary and systemic venous mixing for survival (atrial septectomy). The indications for palliation over corrective surgery have changed over time. Now we reserve palliation for children that require low pulmonary vascular resistance for correction, a conduit that will require replacement as the child grows, or where the risk of the corrective procedure decreases rapidly with age. For palliation with systemic to pulmonary artery shunts, we prefer to perform a Blalock-Taussig subclavian to pulmonary artery shunt using a synthetic (PTFE) tube graft in infants. The operative mortality is higher in infants under 1 month of age but is not affected by weight or diagnosis. Palliative surgery to decrease pulmonary blood flow is restricted primarily to infants with large left-to-right shunts where the risk of correction in infancy is high (multiple VSDs) or not feasible (univentricular heart). The operative risk for pulmonary artery banding is affected mostly by the complexity of the cardiac defect and the clinical state of the infant (severe congestive failure) at the time of surgery. A trial septectomy to improve venous mixing is used mostly in infants with univentricular heart in whom a balloon septostomy was ineffective.(ABSTRACT TRUNCATED AT 250 WORDS)