Aim - to evaluate the course of early postoperative period after total cava-pulmonary anastomosis in children younger 4 years. Material and methods. Since 2011 till 2015 in the department of pediatric cardiac surgery of M.A. Topchibashev Research Center of Surgery and in the department of cardiac surgery of Research and Practical Center of pediatric surgery of the Republic of Belarus extracardiac modification of total cava-pulmonary anastomosis was performed in 32 patients. Average age and body weight were 36.61±6.72 month and 13.48±2.29 kg respectively. In preoperative period all patients underwent electrocardiography, echocardiography and ventriculography. Repeated echocardiographic examination was made postoperatively. Surgery was performed via median sternotomy under cardiopulmonary bypass with Gore-Tex prostheses deployment. In early postoperative period the parameters of inotropic support, duration of ventilation and pleural effusion were controlled. Results. Early postoperative mortality was 6.25%. Acute heart failure occurs in 26% of patients. Average ICU-stay was 60.0±4.5 hours. Mean duration of mechanical ventilation was 33.5±6.2 hours. Conclusion. The results showed that Fontan operation in children younger 4 years minimizes the likelihood of additional risk factors in postoperative period.