Congenital heart disease (CHD) remains a leading cause of pediatric morbidity and mortality, with increasing recognition of its impact on the developing brain. The concept of the heart-brain axis has reshaped how clinicians approach the care of children with CHD, emphasizing the importance of neurodevelopmental outcomes alongside cardiac repair. Brain injury in these patients often begins in utero and continues through the perioperative period, due to factors such as hypoxia, ischemia, and altered cerebral perfusion. Recent advances in neuromonitoring, including near-infrared spectroscopy (NIRS) and continuous electroencephalography (EEG), allow early detection of cerebral oxygenation changes and subclinical seizures, guiding real-time management. Imaging technologies like MRI, three-dimensional cardiac modeling, and four-dimensional flow MRI offer enhanced visualization of cardiovascular anatomy and cerebral blood flow. Molecular biomarkers such as Brain-Derived Neurotrophic Factor (BDNF), S100B, and neuron-specific enolase (NSE) have shown potential in assessing the extent of neurological injury, although further validation is required. Prolonged mechanical ventilation and intensive care stays are associated with poorer neurodevelopmental outcomes, underscoring the need for targeted perioperative strategies. Despite progress, variability in neuromonitoring practices and the lack of standardized neurodevelopmental follow-up protocols persist across centers. Emerging evidence and ongoing trials are driving efforts to optimize surgical timing and integrate neurodevelopmental priorities into routine care. As survival rates improve, long-term quality of life must consider neurological function. An interdisciplinary approach that combines cardiology, neuroscience, and technology is essential to ensure that children with CHD not only survive but reach their full developmental potential.

 

Jose Luis received the opportunity to join The Labatt Family Heart Center at The Hospital for Sick Children in Canada as a Fellow in Pediatric Cardiology at the age of 28. He currently dedicates himself to advancing his knowledge in the field of pediatric ardiology, with a particular focus on utilizing AI and machine learning models to better understand the clinical course of cardiomyopathies. By integrating multidimensional data, José Luis aims to develop predictive models that enhance diagnostic accuracy for diastolic dysfunction identifying distinct phenotypes. He believes this approach will pave the way for earlier interventions for children and could help in anticipating the development of heart failure and other potential complications. Beyond improving diagnostic methods, his research also aims to establish a standardized framework for grading the impact of neurological otucomes in congenital heart disease.  His commitment to both clinical excellence and innovative research continues to drive his medical career, as he strives to contribute to the future of pediatric cardiovascular care as an active member of the Ted Rogers Centre for Heart Research Center.