Single-ventricle physiology can arise from various anatomic and physiologic features beyond the most well-known hypoplastic left heart syndrome. In conditions that affect the pulmonary outflow tract, such as pulmonary atresia, initial palliative surgery often involves the placement of a modified Blalock–Taussig shunt, followed by a bidirectional Glenn and Fontan procedures. Older patients with Fontan physiology can have significant sequelae that are important to assess for preoperatively. Perioperative management of these patients requires attention to maintenance of adequate preload, ventilator strategies to promote pulmonary blood flow, and anesthetic techniques that account for potential long-term single-ventricle sequelae.