Purpose <p>This systematic review and meta-analysis aim to investigate the prevalence of cardiac abnormalities in patients with idiopathic scoliosis.</p> Methods <p>A systematic search on PubMed, Embase, Scopus, and Web of Science was conducted, covering studies published from their inception up to February 2024.</p> <p>Peer-reviewed studies that used echocardiograms to screen for cardiac abnormalities were included. Nine thousand five hundred fifty-four cases met the inclusion criteria and were included in the final data synthesis. A meta-analysis was performed to calculate the pooled prevalence of cardiac abnormalities and a 95% confidence interval (CI). Results were divided into subgroups to reveal the prevalence of each cardiac abnormality for further consideration.</p> Results <p>7.5% had cardiac abnormalities. Valvular diseases are the most common cardiac abnormalities. Tricuspid regurgitation (TR) is the most prevalent, accounting for 24.4% of cases. This is followed by mitral regurgitation (MR) at 17%, mitral valve prolapse (MVP) at 8%, aortic regurgitation (AR) at 3.8%, and pulmonary insufficiency at 1.9%. In addition, other valvular diseases collectively make up 22% of the findings.</p> <p>Congenital heart diseases (CHD) were also included in the results, with atrial septal defect (ASD) being the most prominent at 1.5%, followed by ventricular septal defect (VSD) at 1.4%, and other CHD comprising 2.5%. Pulmonary hypertension accounts for a substantial portion of the results, representing 16.8%. A dilated aortic root and pericardial effusion were observed in 2.4% and 0.9% of cases, respectively.</p> Conclusion <p>Cardiovascular abnormalities are prevalent in patients with idiopathic scoliosis. This highlights the need for thorough cardiovascular screening of these patients before surgical intervention.</p>