The success of surgery for congenital heart disease which has been performed since many years has created a population of patients who require careful follow-up in order to determine their clinical progress and to establish the type and intensity of physical activity which they can safely perform. The authors illustrate the opinion of the European Community regarding children, sport and organizational aspects and also problems concerning the management of pediatric cardiac patients in Europe and Italy. Cardiological and surgical aspects are considered together with the practice of physical activity, with emphasis upon the differences between the various countries. Particular attention is paid to the Italian legislation regarding the certification to participate in competitive or non-competitive sport in such a population of patients. Great importance is given to pediatric cardiac rehabilitation programs which aim at improving the aerobic fitness of patients operated upon for complex congenital heart disease and at illustrating their own cardiovascular limitations so that they can perform physical exercise with the utmost safety.