Brain injury and impaired neurodevelopment is commonly seen in infants who undergo surgery for congenital heart disease during the newborn period.We undertook a long-term follow up study of risk factors for neurodevelopmental impairment at two years in term-born infants with congenital heart disease undergoing surgery early in life.This included neuroimaging with magnetic resonance imaging before and after surgery.Gestational age at birth and brain maturity on pre-operative cerebral imaging were more important risk factors for later impairment than most aspects of surgery and peri-operative care.Emerging research is pointing to the third trimester as a high risk time for impairment of brain development in infants with some cardiac lesions.This may relate to restriction to cerebral blood flow in utero relating to specific structural anomalies and to genetic predisposition to impaired brain development.