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Abstract ABSTRACT Background and Aims: Congenital heart disease (CHD) can cause several abnormalities of the lungs, such as pulmonary overflow (PO), pulmonary hypertension and chest infection like pneumonia. We aimed to assess pulmonary abnormalities using lung ultrasound (LUS) in children with congenital heart diseases. Patients and methods: This is a cross-sectional study, which included (33) CHD patients aged between 0.5 to 3.5 years who were admitted to the Cardiology Unit, Ain Shams University, Children’s Hospital. The patients were examined for any consolidation and for the identification of pulmonary overflow, which is detected by B vertical lines, which appear as a hyperechoic comet tail artefact arising from the pleural line in all lung zones. Patients were evaluated at enrollment and after treatment using a semiquantitative lung ultrasound score (LUS), and lung involvement is frequently divided into four groups: none (0–6) B lines, mild (6–12) B lines, moderate (13-24) B lines, and severe (>24) B lines. Results: The study showed that all the studied cases (100%) had a positive diagnosis of pulmonary overflow using LUS, compared to 28 patients (84.8%) using chest x-ray with no statistical significance (p=0.063). There was a significant reduction in the post-management group compared to the pre-management group according to the LUS score with a p-value of p<0.001. There was a difference in management types based on the LUS score and severity; where, patients with a LUS score of 24.80 ±4.13 before management required surgical management, those with a LUS score of 21.25± 2.31 required medical management, and those with a LUS score of 20.20± 1.26 required catheterization type of management. Regarding the amount of change in LUS score, catheterization-type of management had a greater reduction in the LUS score (7.07±1.10) compared to other types of management among our studied patients (p = 0.031). Conclusion: Lung ultrasound is an ideal tool for the diagnosis and follow-up of pulmonary complications such as lung congestion, pulmonary edema and pneumonia if associated with clinical findings and chest x ray. Also, there was improvement in pulmonary congestion after management among CHD children |