Background/Objectives: Myocarditis is a major cause of morbidity and mortality in children and can lead to long-term heart failure, dilated cardiomyopathy, the need for heart transplantation, or death. New systemic inflammatory indices that combine lymphocyte, neutrophil, and platelet counts have been recently used as strong prognostic markers of some inflammatory diseases and adverse outcomes of neoplasms. This study aimed to investigate the use of new systemic indices as early predictive markers for adverse outcomes in patients with pediatric myocarditis. Methods: This study retrospectively examined patients between the ages of >1 month and <18 years who were monitored in our clinic with a diagnosis of myocarditis between 1 January 2022 and 31 December 2024. The cases were divided into two groups: fulminant myocarditis (requiring the use of inotropes or extracorporeal membrane oxygenation due to hemodynamic disturbance) and non-fulminant myocarditis. The systemic inflammatory index values of these groups (calculated in the first 6 h) were compared, and the results were statistically analyzed. Results: The study included 122 pediatric myocarditis cases treated during the study period (80 boys; median age: 11 (IQR: 8–14) years). Twenty-six of these patients (21.3%) developed fulminant myocarditis. The median systemic immune-inflammation index (SII) value in the group with fulminant myocarditis was 1300 (IQR: 1000–1600), while this value was 500 (IQR: 350–650) for the non-fulminant group (p < 0.05). The median systemic inflammatory response index (SIRI) values were 2.9 (IQR: 2.5–3.2) in the fulminant myocarditis group and 1.5 (IQR: 1.2–1.8) in the non-fulminant group (p < 0.05). The cut-off values for fulminant myocarditis were found to be 1050 for the SII, with an AUC value of 0.76 (95% confidence interval: 0.80–0.96; p < 0.001), and 1.9 for the SIRI, with an AUC value of 0.64. Conclusions: The SII and SIRI may independently predict adverse myocarditis prognoses in children. These new biomarkers are easy to calculate using routine blood parameters.

Background and Objectives: We aimed to assess the effect of AST/ALT ratio on echocardiographic and cardiac magnetic resonance imaging (CMRI) parameters after COVID-19 patients recover. Materials and Methods: 87 patients with COVID-19 were included in the study. The patients were hospitalized with COVID-19 pneumonia, but the patients did not need intensive care unit follow-up or non-invasive mechanical ventilation support. After a discharge and two weeks following the positive swab test result, patients were considered eligible if they had any symptoms. Transthoracic echocardiography (TTE) was performed within 24 h prior to CMRI. The median value of AST/ALT ratio was found, and the study population was divided into two subgroups based on the median AST/ALT ratio value. The clinical features, blood test, TTE and CMRI results were compared between subgroups. Results: C-reactive protein, D-dimer and fibrinogen were found to be significantly higher in patients with high AST/ALT ratio. LVEF, TAPSE, S’, and FAC were significantly lower in patients with high AST/ALT ratio. LV-GLS were significantly lower in patients with high AST/ALT ratio. In CMRI, native T1 mapping signal, native T2 mapping signal and extracellular volume raised significantly in patients with high AST/ALT ratio. Right ventricle stroke volume and right ventricle ejection fraction were significantly lower in patients with high AST/ALT ratio, but right ventricle end systolic volume was significantly higher in patients with high AST/ALT ratio. Conclusion: High AST/ALT ratio is related to impaired right ventricular function parameters with CMRI and echocardiography after recovery from acute COVID-19. Assessment of AST/ALT ratio at hospital admission may be used to assess the risk of cardiac involvement in COVID-19 disease, and these patients may require closer follow-up during and after the course of COVID-19.

Purpose: In patients with repaired tetralogy of Fallot, transcatheter or surgical pulmonary valve replacement is recommended. However, it is not clear whether pulmonary valve replacement preserves systolic and diastolic functions of both ventricles. The aim of the study is to investigate the impact of transcatheter pulmonary valve replacement on atrial and ventricular myocardial strain changes by feature-tracking cardiac magnetic resonance imaging. Materials and methods: Cardiac magnetic resonance imaging of 18 patients (median age 14.5 years) with repaired tetralogy of Fallot before and after transcatheter pulmonary valve replacement were retrospectively analyzed. Feature tracking strain for both left and right atria and ventricles was performed. Cardiac magnetic resonance imaging parameters (volume and function) and strain characteristics (atria and ventricles) were compared before and after transcatheter pulmonary valve replacement. The Wilcoxon rank-sum and Spearman correlation test was used. Results: After pulmonary valve replacement, right ventricular end-diastolic volume, end-systolic volume, and stroke volume decreased, whereas left and right ventricular ejection fractions remained unchanged. Reservoir, conduit and pump strain measurements improved for both left (P = 0.003, P = 0.001, and P = 0.006) and right atria (P = 0.013, P = 0.004, and P = 0.015). Global left ventricular circumferential, longitudinal, and radial strains improved (P = 0.001, P = 0.043, and P = 0.002, respectively). Right ventricle global circumferential strain significantly improved with no significant change in the longitudinal and radial strains (P = 0.007, P = 0.068, and P = 0.055, respectively). Conclusion: Transcatheter pulmonary valve replacement significantly enhances atrial and ventricular strain parameters, indicating a positive impact on overall myocardial function. Feature-tracking cardiac magnetic resonance imaging may offer a comprehensive, non-invasive evaluation of myocardial strain changes in patients with repaired tetralogy of Fallot after pulmonary valve replacement, which leads to improvement of indications and outcomes.

Congenital heart disease (CHD) represents a significant burden in Sub-Saharan Africa (SSA), where limited healthcare infrastructure, inadequate diagnostic facilities, and financial constraints contribute to delayed diagnosis and suboptimal care. Cardiac magnetic resonance imaging (CMR), recognized internationally for its exceptional anatomical and functional cardiac assessment capabilities, remains underutilized in SSA primarily due to inadequate infrastructure, high operational costs, lack of trained professionals, and maintenance requirements. Artificial intelligence (AI) has the potential to revolutionize the role of MRI in CHD diagnosis by reducing scan times, automating image processing, and improving diagnostic accuracy. Despite its potential for improving diagnosis, AI implementation is limited by a lack of local datasets, technological incompatibility, data privacy concerns, and lack of expertise among healthcare providers. Strategic interventions such as adopting low-field MRI technologies, enhancing public-private partnerships, and establishing dedicated cardiac imaging units at tertiary centers could significantly expand CMR access and improve diagnosis of CHD in Sub-Saharan Africa. Additionally, targeted training initiatives and locally developed AI solutions that address ethical and interoperability concerns are essential. This Review explores these strategies and emphasizes how CMR augmented by AI could substantially improve CHD diagnosis, clinical outcomes, and healthcare equity in resource-constrained African settings.

Poland's syndrome is a rare congenital anomaly accompanied by the absence of the pectoralis major, and the ipsilateral upper-limb and chest wall deformities. Hypoplasia of the breast, agenesis of the ipsilateral rib cartilage, athelia, and ipsilateral developmental finger anomalies such as syndactyly can also be seen. In the literature, only 56 cases of dextrocardia and left-sided Poland's syndrome have been described. Herein, a case of left-sided Poland's syndrome coexisting with dextrocardia and nasal hemangioma was presented.