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When employed strategically in select patients, BCPS and atrial level fenestration are effective in managing right ventricular failure in congenital heart disease patients. Pre-operative imaging and intra-operative anatomic and physiologic parameters help guide the appropriate management for a given patient. When employed strategically in select patients, BCPS and atrial level fenestration are effective in managing right ventricular failure in congenital heart disease patients. Pre-operative imaging and intra-operative anatomic and phys