Seed output is lowest in bluff populations with a lot of shade. As yet, the pollination method for dwarf-flowered heartleaf is unproven, but biologists speculate that it may use the same method as its related species. With most Hexastylis species, the vectors, flies and thrips, spend most of their lives in the plant's flower tissues and feed on pollen grains or on portions of the plant's outer skin. Once the flowers have been fertilized, their seeds are distributed by ants. These ants eat the seeds' coatings and leave the seeds near the plant site or by the ant nest.
Seed germination takes place in the spring after the seeds have been exposed to cool temperatures.
Germination in the Dwarf-flowered heartleaf generally occurs in clusters. Some Hexastylis flowering plants, probably including the heartleaf, do not reach flowering age for 7 to 1O years. In the buds are next spring's flowers, and next year's leaf will not grow until the plant flowers again. Timber harvesting, urbanization, conversion from woodlands to pasture, reservoir construction, pond construction, trash, and insecticide use are threatening the remaining populations. The eight populations in Greenville, South Carolina are all endangered by residential, industrial, and commercial expansion.