The diagnosis of congenital heart disease, especially in adults, is a growing concern, given that there are now more adults than children with congenital heart disease. Although some of these pathologies may be asymptomatic, others may involve mild to life-threatening symptoms and/or have important prognostic implications. It is important for radiologists to be aware that undiagnosed congenital heart disease and shunts can be detected on routine chest computed tomography (CT), even without electrocardiography gating, owing to improved technology, and also to know how they can present pre- and postoperatively to avoid delays in diagnosis and complications, since they can be incidentally discovered on routine chest CT ordered for other reasons. This chapter discusses the potential role of routine non-gated chest CT in the diagnosis and management of congenital heart disease and shunts.