The number of children now surviving surgical interventions because of congenital cardiac disease continues to increase. Indeed, it is estimated that, by the end of 2005, there will be more adults than children with congenital cardiac malformations. The complex challenges facing this growing population are only now becoming apparent, including the continued hazard for mortality, the risk of reoperation, and newly-emerging late sequels of surgery. In particular, children with severe lesions requiring intervention in the neonatal period are surviving at levels thought to be highly improbable no more than two decades ago. Heralded by the availability of prostaglandin E1 in the late 1970s, improvements in technology, such as echocardiography, and color Doppler in particular, intensive care and intraoperative support, have recently allowed surgeons to reconstruct the hearts of many children with otherwise lethal defects. Much of the published literature has focused on the cardiac sequels in this population. Increasing attention has recently been given, nonetheless, to the neurodevelopmental outcomes in this population of patients.