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This prospective controlled study recorded the anthropometric data and measured the circulating insulin-like growth factor-I (IGF-I) in 16 children with congenital cyanotic heart disease before and a year after surgical intervention. At presentation patients were significantly shorter [length SD scores (LSDS)=−2.44 ± 1.31], vs. controls (LSDS=−0.25 ± 0.18). After surgical treatment the LSDS and growth velocity SD scores (GVSDS) increased significantly to (−) 0.25 ± 0.95 and 3.7 ± 2.1, respectively. IGF-I increased from 45.7 ± 26.3 ng ml−1 to 67.7 ± 16.4 ng ml−1. The GVSDS after treatment was correlated with the body mass index (BMI) (r=0.339, p < 0.05) and negatively with the LSDS before surgery (r=−0.461, p < 0.05). The percentage increase of IGF-I after operation was correlated significantly with the BMI after surgical intervention (r=0.82, p < 0.001). It appears that the postoperative growth spurt in infants with cyanotic congenital heart disease (CHD) is mediated through activation of the GH/IGF-I system and improved nutrition.