2026-02-13
Fragile heart, vulnerable brain?
Cardiology and Vascular Medicine
By Ana Espino | Published on February 13, 2026 | 3 min read
Congenital heart defects (CHD) are the most common congenital anomalies, affecting approximately 1% of all births. Thanks to significant advances in surgery and medical care, survival rates have greatly improved, transforming what was once a lethal condition into a chronic one. However, this success has brought to light a long-overlooked complication: neurodevelopmental disorders (NDD).
Current management remains primarily focused on the anatomical and functional correction of the heart. Yet a significant proportion of children who undergo surgery later develop cognitive, motor, language, or behavioral difficulties, which are often not detected early. The lack of systematic neurological follow-up, limited integration of multidisciplinary care pathways, and absence of predictive tools hinder effective prevention and support.
The key challenge now is to understand the mechanisms linking cardiac defects to brain vulnerability, starting as early as the prenatal period, in order to guide earlier screening and targeted interventions. One of the most promising avenues is a detailed analysis of heart-brain interactions, using neuroimaging, biomarkers, and developmental trajectories.
In this context, the aim of this review was to investigate the connections between CHD and neurodevelopmental outcomes, by identifying key risk factors, critical periods, and potential strategies for early, comprehensive, and personalized follow-up.
The primary methodological objective was to identify early brain alterations associated with cardiac malformations, and to link these with medium- and long-term neurocognitive outcomes. The analysis also incorporates perioperative factors (such as cardiopulmonary bypass, chronic hypoxia, and postoperative complications), as well as environmental influences (socioeconomic status, family stimulation), which are recognized as modulators of neurodevelopmental risk.
Findings reveal that children with CHD—particularly those with complex cyanotic forms (e.g., hypoplastic left heart syndrome)—present with:
Congenital heart disease is now a better-managed chronic pediatric condition from a hemodynamic standpoint, but it still carries a significant and underrecognized risk of long-term neurodevelopmental complications. The current challenge lies in addressing neurological risks early, starting at the prenatal diagnosis, to improve cognitive, motor, and educational outcomes.
This review aimed to shed light on early interactions between cardiac disease and brain development, and to identify opportunities for prevention and targeted intervention. The evidence confirms that brain vulnerability begins in fetal life, supporting the need for routine neurological follow-up alongside cardiac surveillance.
However, limitations in this review remain and call for further research. These include the need for large, multicenter longitudinal studies, advanced neuroimaging investigations, the identification of early biomarkers of brain vulnerability, and evaluation of targeted intervention programs in both school and home environments. The future of care lies in integrated pediatric cardiology, focused not only on survival but on long-term neurological 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.
Congenital heart defects (CHD) are the most common congenital anomalies, affecting approximately 1% of all births. Thanks to significant advances in surgery and medical care, survival rates have greatly improved, transforming what was once a lethal condition into a chronic one. However, this success has brought to light a long-overlooked complication: neurodevelopmental disorders (NDD).
Current management remains primarily focused on the anatomical and functional correction of the heart. Yet a significant proportion of children who undergo surgery later develop cognitive, motor, language, or behavioral difficulties, which are often not detected early. The lack of systematic neurological follow-up, limited integration of multidisciplinary care pathways, and absence of predictive tools hinder effective prevention and support.
The key challenge now is to understand the mechanisms linking cardiac defects to brain vulnerability, starting as early as the prenatal period, in order to guide earlier screening and targeted interventions. One of the most promising avenues is a detailed analysis of heart-brain interactions, using neuroimaging, biomarkers, and developmental trajectories.
In this context, the aim of this review was to investigate the connections between CHD and neurodevelopmental outcomes, by identifying key risk factors, critical periods, and potential strategies for early, comprehensive, and personalized follow-up.
Could it all begin in utero ?
The primary methodological objective was to identify early brain alterations associated with cardiac malformations, and to link these with medium- and long-term neurocognitive outcomes. The analysis also incorporates perioperative factors (such as cardiopulmonary bypass, chronic hypoxia, and postoperative complications), as well as environmental influences (socioeconomic status, family stimulation), which are recognized as modulators of neurodevelopmental risk.
Findings reveal that children with CHD—particularly those with complex cyanotic forms (e.g., hypoplastic left heart syndrome)—present with:
- Detectable in utero brain abnormalities, especially in the white matter and cortex;
- Reduced cerebral blood flow, impacting neuronal growth and maturation;
- Persistent brain immaturity at birth, observable on MRI even after surgical correction;
- A higher risk of neurodevelopmental disorders in childhood, including lower IQ, attention deficits, dyspraxia, and autism spectrum features.
From heart monitoring… to brain monitoring
Congenital heart disease is now a better-managed chronic pediatric condition from a hemodynamic standpoint, but it still carries a significant and underrecognized risk of long-term neurodevelopmental complications. The current challenge lies in addressing neurological risks early, starting at the prenatal diagnosis, to improve cognitive, motor, and educational outcomes.
This review aimed to shed light on early interactions between cardiac disease and brain development, and to identify opportunities for prevention and targeted intervention. The evidence confirms that brain vulnerability begins in fetal life, supporting the need for routine neurological follow-up alongside cardiac surveillance.
However, limitations in this review remain and call for further research. These include the need for large, multicenter longitudinal studies, advanced neuroimaging investigations, the identification of early biomarkers of brain vulnerability, and evaluation of targeted intervention programs in both school and home environments. The future of care lies in integrated pediatric cardiology, focused not only on survival but on long-term neurological 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.
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