Cardio-neuro: the duo to watch

By Ana Espino | Published on February 13, 2026 | 3 min read

Congenital heart diseases (CHD) are the most common congenital anomalies, affecting about 1% of newborns. Thanks to advances in surgery and improvements in neonatal intensive care, survival among children with CHD has markedly improved, including for the most complex forms. This medical success has, however, brought to light a complication that is still too often overlooked: neurodevelopmental disorders (NDD).  

Management remains largely focused on anatomical and functional correction of the heart, without fully integrating the cerebral impact of the disease. Yet a growing number of studies show that these children present, from early childhood, cognitive, motor, or behavioral impairments that are often neither anticipated nor detected early. Added to this are the lack of systematic neurocognitive follow-up, insufficient multidisciplinary coordination, and the absence of reliable predictive tools, all of which limit the development of personalized prevention strategies.

The main challenge lies in achieving a precise understanding of the mechanisms linking cardiac dysfunction to cerebral vulnerability, starting in the prenatal period, and in identifying high-risk children before the overt appearance of symptoms. A promising therapeutic avenue is based on integrating brain imaging, developmental biomarkers, and environmental factors to predict and prevent long-term sequelae.

In this context, the present study was initiated to review the interactions between congenital heart disease and neurodevelopmental disorders, identifying early risk factors, critical windows for intervention, and potential levers for comprehensive and anticipatory care.

Does the brain pay the price for the heart ?

This review is based on the analysis of clinical, neurodevelopmental, and brain imaging data from studies conducted in children with congenital heart disease, from the prenatal period through childhood. Sources include longitudinal cohorts, structural and functional brain MRI examinations, and standardized cognitive assessments. The study examines the links between cardiac anomalies, impaired cerebral perfusion, neurological immaturity, and neurodevelopmental disorders. It also considers the impact of perioperative factors (hypoxia, surgery, cardiopulmonary bypass) and the family environment on child development.  

Brain imaging methods reveal that children with CHD show alterations in brain maturation as early as in utero, particularly affecting white matter and the cortex. These abnormalities persist after birth, with delayed brain development observable on MRI.

The results highlight that certain malformations, such as hypoplastic left heart syndrome, expose children to a chronic reduction in cerebral blood flow, leading to delayed neuronal growth. After surgery, complications such as hypoxia, inflammation, or prolonged use of cardiopulmonary bypass further worsen prognosis.

Clinically, children show a high risk of reduced IQ, attention disorders, dyspraxia, autism spectrum disorder, or learning difficulties. The postnatal environment (family support, cognitive stimulation) appears to be a key compensatory factor.

Thinking beyond the heart

Congenital heart diseases are now better controlled from a hemodynamic standpoint, but they expose children to a high risk of neurodevelopmental disorders that remain largely underestimated. The main challenge lies in the lack of integrated approaches capable of considering, from the prenatal period onward, the cerebral impact of these anomalies. This review aimed to explore early links between cardiac pathology and brain development in order to identify at-risk children and anticipate appropriate interventions.  

Available data confirm that neurological vulnerability exists from fetal life, influenced by hemodynamic, surgical, and environmental factors, and that it can have lasting consequences on cognitive, motor, and behavioral development.

However, limitations of this study remain and justify further research. Future work should include multicenter longitudinal studies, the integration of advanced brain imaging techniques, the identification of early biomarkers of vulnerability, and the evaluation of targeted intervention programs in school or family settings. It will also be crucial to develop systematic neurocognitive screening protocols and to strengthen collaboration between specialties, in order to foster a truly integrated pediatric cardiology approach focused on long-term overall quality of life.  




About the author – Ana Espino
PhD in Immunology, specialized in Virology  
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.