Many intrauterine lesions often involve fetal heart,cardiovascular function that probably declines in early stage of disease will provide useful information in diagnosis,opportune time and prognosis.Recently,assessment of cardiovascular function has been changed gradually from a single index to the comprehensive evaluation system,in this paper,advances on cardiovascular function of fetus will be reviewed.

Objective To evaluate the fetal cardiovascular function in selective intrauterine growth restriction (sIUGR)in monochorionic diamniotic(MCDA)twins by using 2D and color Doppler ultrasonography. Methods Twenty - four sIUGR pregnancies and 20 normal MCDA twins pregnancies were enrolled at the First Affiliated Hospital of Sun Yat - Sen University from December 2013 to September 2014,and cardiac structure of fetus and Doppler patterns of the umbilical artery(UA),umbilical vein(UV),pulsatility index of ductus venosus(DV - PI),atrioventricular valve, semilunar valve,tricuspid annulus systolic displacement(TAPSE),fractional shortening of left ventricle short axis(FS) and myocardial performance index(Tei index)of both ventricles were assessed. Results Cardiothoracic ratio,heart rate,DV - PI,FS,TAPSE,Tei index of the left ventricle(0. 34 ± 0. 03,0. 34 ± 0. 04),Tei index of the right ventricle (0. 35 ± 0. 03,0. 35 ± 0. 03)were not significantly different compared with those of the normal MCDA twins(all P ﹥0. 05). Cardiothoracic ratio,ventricular wall thickness,isovolumetric relaxation time( IRT),isovolumetric contraction time(ICT),TAPSE and tricuspid regurgitation(TR)in the larger twins of sIUGR were significantly bigger than those in the smaller twins of sIUGR(all P ﹤ 0. 05),Tei index of both ventricles in the larger twin of sIUGR was significantly higher than that in the smaller twins of sIUGR(Tei index of left ventricle:0. 43 ± 0. 06 vs 0. 35 ± 0. 04,Tei index of right ventricle:0. 43 ± 0. 06 vs 0. 34 ± 0. 04,P ﹤ 0. 05),the peak E in early diastolic / the peak A in atrial contraction (E/ A),the percentage of inflow during of cardiac cycle length(inflow/ CCL)in larger twin of sIUGR were significantly lower than those in smaller twin of sIUGR(all P ﹤ 0. 05). Conclusions There was no difference of cardiac function in normal MCDA twins,at the beginning of the diagnosis of sIUGR,cardiac dysfunction were found in larger twin,follow -up examination are helpful to clinical decision.

Objective To explore the feasibility and efficacy of transcatheter closure of residual shunts after interventional therapy of patent ductus arteriosus (PDA). Methods A total of 16 patients (12 females, 4 males) with residual shunt after the first interventional therapy underwent transcatheter closure of residual shunt using different devices by arterial or venous route from March 1997 to August 2001. The median age was 5.9 years (range 2-9 years) and median weight was 17.7 kg (range 9-28 kg). The mean interval between the first procedure and the second procedure was 1.5 years (range 1 d-3.5 yr). Results The median minimal diameter of residual shunt was 2.7 mm (1.2-5.0 mm). Transcatheter occlusion was successfully performed in 15 patients and the success rate reached to 94% (15/16). Eleven Cook detachable coils, two Amplatzer Duct Occluders (ADO), one Sideris device, and two Rashkind devices were placed in 9 (two coils in 2 patients), 2, 1, and 2 patients respectively. One Sideris device and one Cook detachable coil were placed in one patient simultaneously. The complete occlusion rate of the residual shunts was 80% (12/15) assessed by angiography immediately. The mean procedure time was 75 min (45-120 min) and the mean fluoroscopy time was 10.4 min (5-20 min). All residual shunts were found to be completely closed 24 h after the procedure by echocardiography. Complication was encountered in one patient with loss of the pulse of the femoral artery. There were no device migration and pulmonary arteries obstruction in all patients at mean 2 years follow-up. Conclusion Transcatheter closure of residual shunt after the first interventional therapy is a feasible, effective alternative of surgical procedure.

Objective To evaluate Doppler spectrum of ductus venosus(DV) in selective intrauterine growth restricted(sIUGR) pregnancies.Methods Thirty-five sIUGR pregnancies and 35 normal single pregnancies with same gestational week were enrolled,there were 10 sIUGR Ⅰ,13 sIUGR Ⅱ and 12 sIUGR Ⅲ in sIUGR.Spectrum of ductus venosus,such as DV S wave,DV D wave,DV A wave,DV PI,DV PLI and S/A were assessed.Results ① There was no significantly difference in spectrum of ductus venosus between bigger of sIUGR,smaller of sIUGR Ⅰ with normal fetus (all P ＞0.05).② Compared with normal fetus,DV-PI,DV-PLI and S/A were significant higher in smaller of sIUGR Ⅱ and sIUGR Ⅲ (P ＜0.05);DV-S wave,and DV-D wave showed no significantly difference in smaller of sIUGR Ⅱ and sIUGRⅢ (P ＞0.05).Conclusions Spectrum of ductus venosus in bigger of sIUGR and smaller of sIUGR Ⅰ are mainly normal,and nearly in good condition in utero,inversely,abnormal spectrum of ductus venosus commonly exists in smaller of sIUGR Ⅱ and sIUGR Ⅲ,and supervision should be done carefully in these group.

Objective To evaluate retained fetal cardiovascular function after radio frequency ablation in complicated monochorionic diamnionic twins.Methods A total of 19 complicated monochorionic diamnionic twins [10 twin-twin transfusion syndrome (TTTS) and 9 selective intrauterine growth restricted (sIUGR)] who were diagnosed at Fetal Medicine Center of the First Affiliated Hospital of Sun Yat-Sen University from December 2013 to July 2015 were enrolled,and the cardiovascular profile score (CVPS) and Tei index of retained fetus were measured preoperatively and postoperatively at 24 h,3 days,1 week,1 month,2 months respectively.Each case was matched by normal fetuses with same gestational age as control group and the same parameters were measured.Results (1) TTTS:CVPS [(8.71 ± 1.11) scores] was increased significantly at 3 days postoperatively compared with preoperation [(6.86 ± 2.12) scores],and there was a statistical significance (t =2.571,P ＜ 0.05);CVPS [(9.29-± 0.95) scores] had no statistical significance 1 month postoperatively (P ＞ 0.05) as compared with controls [(10.00 ± 0.00) scores].Tei indexes of the left ventricle (LV-Tei) (0.41-± 0.06) and Tei indexes of the right ventricle (RV-Tei) (0.42 ± 0.06) decreased as compared with those before operation (LV-Tei:0.66 ± 0.19,RV-Tei:0.63 ± 0.12) with significant difference (LV:t =-3.193,P ＜ 0.05;RV:t =-3.565,P ＜ 0.05),but there was no statistical significance 1 month after operation(all P ＞ 0.05) as compared with the controls (LV-Tei:0.35-± 0.03,RV-Tei:0.35-± 0.03).(2) sIUGR:CVPS [(9.71 ± 0.45) scores] showed no statistical significance 1 week after operation (P ＞ 0.05) as compared with controls [(10.00 ± 0.00) scores].Tei indexes of the right and left ventricle 1 week after operation were lower than after operation with significant difference (LV-Tei:0.39 ± 0.04 vs.0.47 ± 0.06,t =-6.687,P ＜ 0.01;RV-Tei:0.38 ± 0.04 vs.0.47 ± 0.05,t =-6.000,P ＜ 0.01).Compared with the controls,RV-Tei (0.38 ± 0.04)had no statistical significance 1 week after operation (P ＞ 0.05),LV-Tei (0.36-± 0.02) showed no statistical significance 1 month after operation (P ＞ 0.05).Conclusions Retained fetal cardiovascular function of TTTS and sIUGR can be restored obviously after operation.In TTTS,its cardiovascular function is recovered completely 1 month postoperatively.In sIUGR,its cardiovascular function is recovered completely 1 week postoperatively.

Objective To explore the development and interaction of left and right ventricular function in healthy children using tissue Doppler imaging.Methods Healthy children aged 0-15 years and adolescents were recruited,then children were divided into 6 groups:0-1 year,＞ 1-3 years,＞ 3-6 years,＞ 6-9 years,＞ 9-12 years,＞ 12-15 years.Healthy adolescents aged ＞ 15-25 years were also recruited.Every subject underwent echocardiography including cardiac dimension measurements,atrio-ventricular valvular velocity and early-diastolic flow velocity(E)/late-diastolic flow evlocity(A) ratio measured by pulsed color Doppler,atrio-ventricular annular myocardial velocity (including systolic velocity (s),early diastolic velocity (e) and late diastolic velocity (a)),time intervals (including isovolumic contraction time,ejection time and isovolumic relaxation time),isovolumic acceleration (ⅣA) and Tei index measured by tissue Doppler imaging.Results were compared among different groups,the correlations with age and other factors were explored.Furthermore,comparison was done between left and right ventricular functional parameters.Results Left ventricular Tei index and isovolumic contraction time were significantly lower during puberty.From infancy to pre-school stage,left ventricular E/A (flow velocity) and e/a(tissue velocity) increased accordingly,then presented with no significant changes among the following age groups(P ＞ 0.05).There were no significant differences in right ventricular Tei index,ⅣA,E/A (flow velocity) and e/a (tissue velocity) among the 6 groups (P ＞ 0.05).Left ventricular systolic myocardial velocity (s) and ⅣA were significantly lower than right ventricle (all P ＜ 0.001).However,left ventricular E/e(flow velocity) and e/a(tissue velocity) were significantly greater than right ventricle (all P ＜0.001).Conclusions In healthy children,left ventricular systolic function enhances during puberty,diastolic function increases from infancy to pre-school stage,then keeps stable till adolescents.Right ventricular systolic and diastolic function present with no significant changes during growth.Left ventricular diastolic function is greater than right one,however,right ventricular longitudinal systolic function is greater than left one.

Objective To explore the value of transseptal puncture for left-sided accessory pathway in radio-frequency catheter ablation in children with paroxysmal supraventricular tachycardia(PSVT). Methods Thirty-three patients with PSVT who had underwent radiofrequency catheter ablation in the First Affiliated Hospital,Sun Yat-Sen University from January 2012 to December 2017 were retrospectively analyzed. All the cases were treated by transaortic approach(transaortic group)or transseptal approach(transseptal group). The immediate success rates,total fluoroscopy time and radiation exposure between 2 groups were compared,and the perioperative complications and recurrence rates were observed between 2 groups. Results Thirty-three cases of children were enrolled,22 cases were male and 11 cases were female. Nineteen cases were treated by transaortic approach(transaortic group),while 18 cases were treated by transseptal approach(transseptal group),including 4 recurrent cases in the transaortic group who were switched to transseptal approach because of previous treatment failure. The age was(10. 16 ± 3. 06)years and(10. 67 ± 2. 20) years,and the weight was(37. 68 ± 14. 28)kg and(37. 33 ± 8. 64)kg,respectively. There were no significant diffe-rences in age and weight statistics between 2 groups(all P>0. 05). The total fluoroscopy time was(20. 16 ± 11. 41) minutes and(12. 56 ± 5. 23)minutes,and the median dose of radiation exposure was 67. 0 mGy and 33. 5 mGy,re-spectively. The postoperative recurrence rate was 21%(4/19 cases)and 0(0/18 cases),respectively. There were sig-nificant differences in total fluoroscopy time,radiation exposure and recurrence rate statistics between 2 groups( t ＝2. 627,Z＝ -2. 31,χ2 ＝4. 249,all P<0. 05). No complications were found in both 2 groups. Conclusions It is safe and feasible by transseptal puncture for left-sided accessory pathway in radiofrequency catheter ablation in children with PSVT. Radiofrequency catheter ablation by transseptal approach could significantly reduce the postoperative recu-rrence rate,and should be the first choice for left-side accessory pathway in children.

Objective To investigate the risk factors of extubation failure following surgical repair of congenital heart defects (CHD) in infants.Methods Infantile patients who underwent surgical repair of CHD under cardiopulmonary bypass (CPB) in the First Affiliated Hospital of Sun Yat-Sen University from January 2015 to October 2016 were included.According to results of extubation,the patients were divided into the extubation failure group and extubation success group.Clinical and laboratory data were collected and analyzed,including age,gender,body mass,the types of congenital heart disease,extracorporeal circulation time and the use of vasoactive drug,et al.Results Sixty cases were enrolled in this study.Among them 12 cases (7 males,5 females with the boy to girl ratio of 1.4 ∶ 1.0,and average age was 0.56 years old) were in the extubation failure group,in which 3 cases (25.0％)aged ＜3 months,5 cases(41.6％) aged 3-6 months.Eight cases(66.7％) weighed ≤5 kg and 4 cases(33.3％)weighed ＞ 5-10 kg.Forty-eight cases (27 males,21 females;the boy to girl ratio was 1.2 ∶ 1.0 and average age was 1.15 years old) were in the extubation success group.The distribution of age and body weight were significantly lower in the extubation failure group than those in the extubation success group [0.42 (0.37) years old vs.1.00 (1.08)years old,Z=-3.22,P＜0.01;5.00 (1.25) kgvs.8.40 (3.95) kg,Z=-3.57,P＜0.01].The durations of CPB and mechanical ventilation until the initial extubation were significantly longer in the extubation failure group than those in the extubation group [114.0 (110.O) minutes vs.80.0 (45.0) minutes,Z =1.59,P ＜ 0.05;142.5 (229.5)hours vs.14.0 (48.9) hours,Z =2.00,P ＜ 0.05].The incidences of airway spasm and pulmonary infection had no difference between the 2 groups (x2 =4.00,5.54,all P ＞ 0.05).Multiple Logistic regression showed thatthe duration of CPB was an independent risk factor of extubation failure [odds ratio (OR) =0.967,95％ CI:0.956-0.997,P =0.024].Conclusions The risk factors of extubation failure include young age,low body weight,and prolonged CPB and mechanical ventilation.CPB time is an independent risk factor of extubation failure following cardiac surgery in infants.