[18F]FDG PET/CT advanced imaging in crucial management steps of a child affected by hypoplastic left heart syndrome

a 6-year-old girl with hypoplastic left heart syndrome (HLHS) associated with turner syndrome (TS) was submitted to multiple reconstructive surgery and afected by a recent episode of cardiac infection. after adequate medical therapy, [18]FDG PET imaging was performed ruling out the presence of a persistent/residual infection, and the patient was included in the transplantation list to give a chance of an improved survival life expectation. virtual CT rendering (a) provides a summarized picture of the main cardiac devices. as detectable by fused images (right column), hybrid PET/CT imaging showed no signs of infection near the stent inside the shunt (b, yellow dotted circle), the surgical clips and the stents in the lung branches (c, white arrows), and the de-functionalized conduit by surgical clips (d, red dotted circle). after a proper preparation, a suppressive physiological uptake was clearly detectable in the single right ventricle, ruling out an active endocarditis (e–f, red asterisk). association between HLHS syndromes and TS results in a poor prognosis considering congenital cardiac anomalies and the related high-risk surgical procedure, worsened by the severe edema in postoperative courses caused by lymphatic abnormalities [1]. infection of the cardiac prosthetic devices could lead to important clinical complications, and the diagnostic role of [18]FDG PET imaging is well-documented in suspected endocarditis [2–4]. [18]FDG PET imaging could also represent a useful non-invasive diagnostic tool for clinical management and surgical strategy decisions in assessment of children with complex cardiopathy (as HLHS) in crucial steps of disease.