Structural cerebral abnormality prevalence rises from 23.1% prenatally to 50.3% postoperatively in isolated congenital heart disease

CONTEXT: Children with congenital heart disease (CHD) are at risk of cerebral abnormalities. Current evidence is limited by small sample sizes, single-center cohorts, and single time points. OBJECTIVE: Conduct a systematic review and meta-analysis to determine the prevalence of structural cerebral abnormalities on magnetic resonance imaging (MRI) in children with CHD during prenatal, postnatal-preoperative, and postoperative periods. DATA SOURCES: Five electronic databases from inception to August 4, 2025. STUDY SELECTION: Studies published in English in peer-reviewed journals that met the following criteria: 1) samples comprised fetuses from 24 weeks gestation to birth or children from birth to 21 years, with 2) isolated (nonsyndromic) CHD with or without surgical intervention within the first year of life, and 3) reported structural cerebral abnormalities on MRI, during 4) prenatal, postnatal-preoperative, or postoperative period. DATA EXTRACTION: Data were extracted independently by 2 authors. Data were synthesized using random-effects modeling to determine pooled estimates. RESULTS: Overall, 125 studies met the inclusion criteria. Sample size included 521, 1895, and 2443 fetuses and children with CHD for prenatal, postnatal-preoperative, and postoperative analyses, respectively, ensuring sample independence. The pooled overall prevalence of structural cerebral abnormalities was 23.1%, 36.7%, and 50.3% for prenatal, postnatal-preoperative, and postoperative periods, respectively. LIMITATIONS: Variations in MRI strength, postnatal vs fetal MRI detection capacity, and the underlying rationale for neuroimaging. CONCLUSIONS: Structural cerebral abnormalities are prevalent in a considerable number of fetuses and children with CHD. A further increase is evident postoperatively, indicating the potential adverse impact of surgical intervention and postoperative care on brain outcomes.