Background: Diagnosis of Infective Endocarditis (IE) can be challenging due to negative blood cultures and difficulties in imaging. Transesophageal echocardiography (TEE) is the gold standard but due to the anterior location of the pulmonary valve and sedation requirement, TEE could be challenging. The aim of this study was to assess the value of Cardiac CT (CCT) for IE in children and young adults with congenital heart disease (CHD). Methods: This is a retrospective review of pediatric patients with CHD and diagnosis of IE who underwent CCT (2018-22). Retrospectively Gated CCT was performed. Data collected included age, gender, cardiac diagnosis, clinical presentation, echocardiographic / CCT/ PET findings, and blood culture results. In addition, Modified Duke criteria(MDC) for the diagnosis of IE were applied with and without CCT as the diagnostic imaging criterion. Results: Fourteen patients were included in this study with median age 11 years old. Nine patients were female. Ten of 14 patients had IE of the RV-PA conduit and 4 patients had IE of the aortic valve. Using MDC, 4 patients had definite IE. Including CCT findings 11 patients (79 %) met MDC for definite IE. Blood cultures were positive in 12 patients. CCT revealed the following complications: thromboembolic findings / pseudoaneurysms in 5 patients each and prosthetic valve perforation/ prosthetic valve leak in one patient each. Conclusions: This study reinforces the complimentary role of CCT to echocardiography in the work up and diagnosis of IE in patients with CHD. With further improvement in lower radiation exposure, CCT may have a key role in the diagnostic work up of endocarditis and could be implemented in the diagnostic criteria of IE.

Cor triatriatum sinister (CTS) is a rare congenital cardiac malformation. In CTS, a fibromuscular membrane subdivides the left atrium into 2 chambers. The communication between the 2 chambers is through 1 or more orifices in the dividing membrane. We present an interesting case of a 2-month-old infant with obstructed CTS membrane who first presented on account of poor feeding and failure to thrive. Echocardiography showed a persistent levoatrial cardinal vein (LACV) connecting the left atrium and the innominate vein. This allowed the proximal left atrial chamber to decompress its blood volume into the innominate vein and subsequently the superior vena cava. There was minimal prograde blood flow across the Cor triatriatum membrane, so the majority of pulmonary venous blood ultimately returned to the heart by way of the decompressing vertical vein into the systemic venous circulation. Surgical repair was performed with an uneventful postoperative course. The specific anatomical variant of Cor triatriatum found in our subject has rarely been reported.

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Noninvasive detection of myocardial inflammation can be challenging. Up to 73% of patients recovered from COVID-19 had increased native T1 on cardiac MRI1 representing inflammation or edema. Therefore, we tested whether hyperpolarized (HP) [1-13C]pyruvate detectis post-COVID-19 inflammation in the myocardium. HP [1-13C]lactate has been suggested as a surrogate imaging marker of inflammation in the heart2,3, attributed to increased glycolytic activity in infiltrating white cells plus a possible increase in activity of lactate dehydrogenase. We demonstrate the feasibility of imaging with HP [1-13C]pyruvate as noninvasive method to detect metabolic changes that may identify cardiac inflammation in the convalescent stage after COVID-19.