We investigate in more detail the relationship between congenital heart disease (CHD), CBF, and neurocognitive outcome in older children by employing a novel voxelwise mediation analysis with CHD status the independent variable, NIH Toolbox scores the dependent variable, and voxelwise CBF the mediating variable. CHD patients display reduced CBF in the salience network (insula, medial prefrontal, caudate) which mediates lower performance on tests of memory and language function. However, the reduced CBF in the salience network mediates improved performance of executive function (flanker inhibitory control) likely due to less filtering out of presumed irrelevant but actually relevant information.
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