Background: Inter-cavitary communications (ICCs) are the most common congenital heart malformations and contribute substantially to paediatric morbidity in sub-Saharan Africa.

Objective: To synthesise epidemiological, clinical, paraclinical and therapeutic data on ICCs, to analyse correlations among variables, and to explore complication patterns according to defect type.

Methods: Systematic review and meta-analysis integrating 6 observational studies (2010–2024) including 951 children with congenital heart disease (876 in the primary meta-analysis). Multivariate correlation analysis (Spearman), bivariate cross-tabulation and subgroup comparisons were performed.

Results: ICCs accounted for 58.9% of all congenital heart defects (95% CI: 51.2–66.1%). Ventricular septal defect (VSD) predominated (35.2%), followed by atrial septal defect (ASD, 17.6%) and atrioventricular canal (8.7%). Mean age at diagnosis was 24.9 ± 8.3 months. Overall complications affected 38.1% of patients, dominated by heart failure (40.2%) and pulmonary hypertension (28.6%). Aortic regurgitation was almost exclusively associated with VSD (10.3%, p < 0.001). Only 24.3% of patients received surgical treatment, of whom 71.2% were operated abroad. A moderate positive correlation was observed between age at diagnosis and pulmonary hypertension (r = 0.42, p = 0.014). Surgical treatment correlated strongly with a reduction in complications (r = -0.67, p = 0.012).

Conclusion: ICCs represent a major burden in sub-Saharan Africa, characterised by late diagnosis and limited local treatment capacity. Improving early screening and strengthening surgical capacity are imperative to improve outcomes.