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This research article demonstrates, for the first time, echocardiographic evidence of a transition in left ventricular vortex patterns from the newborn to the adult period, with an associated change in cardiac efficiency, marked by increased energy loss, during infancy.

Purpose: CMR derived left ventricular longitudinal and circumferential strain is known to be abnormal in myocarditis. CMR strain is an useful additional tool that can identify subclinical myocardial involvement and may help with longitudinal follow-up. Right ventricular strain derived by CMR in children has not been studied. We sought to evaluate CMR derived biventricular strain in children with acute myocarditis. Methods: Children with acute myocarditis who underwent CMR 2016 - 2022 at our center were reviewed, this group included subjects with COVID-19 myocarditis. Children with no evidence of myocarditis served as controls Those with congenital heart disease and technically limited images for CMR strain analysis were excluded from final analysis. Biventricular longitudinal, circumferential, and radial peak systolic strains were derived using Circle cvi42. Data between cases and controls were compared using an independent sample t-test. One-way ANOVA with post hoc analysis was used to compare COVID-19, non-COVID myocarditis and controls. Results: 38 myocarditis and 14 controls met inclusion criteria (14.4 ± 3 years). All CMR derived peak strain values except for RV longitudinal strain were abnormal in myocarditis group. One-way ANOVA revealed that there was a statistically significant difference with abnormal RV and LV strain in COVID-19 myocarditis when compared to non-COVID-19 myocarditis and controls. Conclusion: CMR derived right and left ventricular peak systolic strain using traditionally acquired cine images were abnormal in children with acute myocarditis. All strain measurements were significantly abnormal in children with COVID-19 even when compared to non COVID myocarditis.

There is very limited experience with simulated virtual implantation of left ventricular assist devices (LVADs) to assess device fitness in pediatric patients. In this clinical vignette, we report the case of a 9-year-old male patient with dilated cardiomyopathy who underwent successful placement of an LVAD after virtual simulated implantation was performed. (

Hypoplastic left heart syndrome includes various lesions that ultimately result in a small left ventricle along with the underdeveloped aortic and mitral valves, as such the left ventricle cannot handle systemic circulation. It is a severe form of congenital heart defect with 100% fatality without treatment in the neonatal period. Multidisciplinary team-based approaches along with technical advances in staged surgeries to achieve single ventricular circulation have improved survival for this otherwise lethal condition. Knowledge of unique hemodynamics associated with Fontan physiology is necessary for appropriate management of this population and to address potential complications. Cardiac CT is being increasingly used after single-ventricle palliation in patients with hypoplastic left heart syndrome.

Left ventricular outflow tract and aortic valve anomalies in a biventricular circulation are a heterogeneous group of lesions with resultant obstruction below, at the level of, and above the aortic valve. Valvar aortic stenosis accounts for the majority of left ventricular outflow obstructive lesions with predominance of bicuspid aortic valve disease. Majority of aortic stenosis progresses over time; clinically significant aortic stenosis will need intervention in the neonatal period. Current management strategies are evolving with improved understanding of this heterogeneous condition.

Congenital mitral valve anomalies are rare in isolation, they are often associated with other heart defects, and as such their presence warrants thorough evaluation, especially of the left-sided structures. Mitral valve and its support structures have a complex three-dimensional structure with a non-planar saddle shape that makes two-dimensional evaluation difficult. Three-dimensional echocardiography has made tremendous advances and is currently the preferred imaging modality. Cardiac CT is complementary to other methods to evaluate the mitral valve. Management of the congenital mitral valve anomalies is individualized based on the encountered anatomic variations.

Isolated systemic venous anomalies are rare, and they are frequently associated with congenital heart defects (CHD). Embryological development of the systemic veins is a complex process that helps understand the venous anomalies. Majority of the systemic venous anomalies are of no hemodynamic significance as the deoxygenated blood ultimately returns to the right atrium. Left superior vena cava draining to the right atrium via dilated coronary sinus is a common systemic venous anomaly in the general population. Heterotaxy syndromes are associated with higher incidence of both systemic and pulmonary venous anomalies. Knowledge of systemic venous anomalies is necessary for appropriate management of the CHD patients.

Anesthesiologists are frequently responsible for placement of transesophageal echocardiography probes prior to cardiac surgery in children. A number of potential complications are possible, including placement failure. This report documents one such failed attempt at probe placement in a 3-month-old patient with a history of ventricular septal defect, and the utilization of video laryngoscopy by the anesthesiologist to diagnose a previously unknown extrinsic esophageal compression likely caused by an aberrant right subclavian artery. This case highlights the multiple vascular anomalies that may act as a source of esophageal obstruction in children undergoing transesophageal echocardiography for cardiac surgery.

Septal defects together account for the majority of the congenital heart defects (CHD); these can occur in isolation or associated with other CHDs. Hemodynamic manifestations are dependent upon the size, location, and the number of the defects, along with the associated lesions. For example, atrial septal defects result in the right ventricular volume overload, whereas the ventricular septal defect (VSD) results in the left heart volume overload. Knowledge of septal anatomy is crucial to understanding these lesions, their hemodynamic significance, and thus better plan management, including interventions. Noninvasive imaging of simple septal defects by various modalities will be reviewed; atrioventricular septal defects, anomalous pulmonary venous connections, patent ductus arteriosus, and complex cardiac conditions with VSD will not be discussed in this chapter.