PEDIATRICS: Edited by James C. HuhtaOperations for improving left ventricular diastolic functionEmani, Sitaram M.a; Marx, Gerald R.bAuthor Information aDepartment of Cardiac Surgery, Boston Children's Hospital bDepartment of Cardiology, Children's Hospital and Department of Pediatrics, Harvard School of Medicine, Boston, Massachusetts, USA Correspondence to Gerald R. Marx, MD, Department of Cardiology, Boston Children's Hospital Department of Pediatrics, 300 Longwood Avenue, Boston, MA 02115, USA. Fax: +1 617 739 6282; e-mail: [email protected] Current Opinion in Cardiology: January 2016 - Volume 31 - Issue 1 - p 101-108 doi: 10.1097/HCO.0000000000000250 Buy Metrics Abstract Purpose of review With a combination of fetal catheter interventions and postnatal catheter and surgical interventions, the left ventricle in patients with hypoplastic left heart can undergo significant increase in size and remodeling to support cardiac output. However, some will have persistent high left atrial pressures resulting in pulmonary edema and high pulmonary artery pressures, that is, diastolic dysfunction. Recent findings The manuscript details the medical and surgical strategies to diagnose and treat diastolic dysfunction in this patient population to promote biventricular circulations. Summary Often times, this diastolic dysfunction is related to the presence of endocardial fibroelastosis, which affects left ventricular filling and mitral valve function. Ongoing research is investigating what causes and promotes the development of endocardial fibroelastosis, and means to improve the medical and surgical treatment of diastolic dysfunction. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.