Infants with congenital heart disease (CHD) have altered brain development. We characterized cortical folding, a critical part of brain development, in CHD infants and demonstrated an overall decrease in cortical surface area and cortical folding with regional alterations in the right lateral sulcus and left orbitofrontal region, cingulate region, and central sulcus. These abnormalities were present prior to surgery. Keywords Brain; magnetic resonance imaging; neonate; cardiac Infants with

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... nital heart disease (CHD) requiring surgery in early infancy are at increased risk for impaired neurodevelopment. Magnetic resonance imaging (MRI) has demonstrated alterations in brain development and growth in this population [1, 2] . Recent advances in MRI techniques have improved characterization of brain development in the newborn and may provide insights into potential mechanisms of adverse neurological outcomes. One such technique is surface-based analysis, which depicts cortical folding and sulcation, a vital part of brain development. Measures of cortical growth appear to be predictive of neurocognitive outcome in later childhood [3] , and preliminary data in a small number of infants with CHD revealed less curvedness and concavity within the operculum, with subtle differences existing between infants with hypoplastic left heart syndrome and transposition of the great arteries [4] . Surface-based analysis of the fetus has also suggested