Objective To summary the echocardiographie features of the patients with dissection into interventricular septum (IVS) and to analyze the etiology.Methods The data of 13 cases with the dissection into the interventricular septum diagnosed by echocardiography were reviewed to summarize the echocardiographic features and the analysis of etiology.Results Among the 13 patients with dissection into IVS,11 patients were dissected into IVS from the right sinus of Valsalva (SOV),in which 5 patients were from single aneurysm of the right SOV,one patient was from a combination of a bicuspid aortic valve and right SOV,4 patients were from aortic valve infection of infective endocarditis,and one patient was induced by severe paravalvular leak after mechanical aortic valve prosthetic replacement was complicated by annular detachment.In all 11 patients,eehocardiography showed a dissecting cystic-like mass in the IVS from the base to mid septum or confined to the septal base.The path of the dissection in all these patients was traced to the right SOV.In the other 2 patients,IVS dissection followed septum rupture due to a myocardial infarction.Conclusions Echocardiography could accurately diagnose dissections of the IVS and to analyze the etiology,which is very helpful to make the clinical medical strategy.

Objective To explore the diagnostic sensitivity and specificity of echocardiography parameters ,and the diagnostic value of multiple parameters score . Methods Forty‐nine cases of the fetus checked by fetal echocardiography and were indicated aortic coarctation . According to the results of follow‐up ,the cases were divided into the positive and negative groups . Comprehensive analysis were performed in fetal echocardiography parameters ,such as diameter ratio and velocity ratio of ventricle ,aorta ,pulmonary artery ,ductus artery ,middle cerebral artery and umbilical artery . Results Diameter ratio of left ventricle/right ventricle ( LV/RV ) ,pulmonary artery/aorta ( PA/AO ) ,aortic isthmus/ductus artery ( AI/DA ) ,and velocity ratioof middle cerebral artery/inner umbilical artery ( MCA/inUA ) were calculated ,ROC curve showed their area under ROC were>0 .5 with a significant statistical significance ( P < 0 .05) . The Chi‐square test showed that the consistency of any single ratio was relatively low . When the number of the ratiois increased to 3-4 ,the Kappa value was 0 .687( P = 0 .000) and 0 .649( P = 0 .000) ,respectively , which had relatively high diagnostic value . Conclusions Ultrasonic diagnosis of fetal coarctation of aorta has certain difficulty ,and the value of single hemodynamic parameter of fetal echocardiography in diagnosis of fetal aortic coarctation is lower ,so that the comprehensive evaluation and combined multiple ultrasonic parameters can improve the sensitivity and specificity of ultrasound diagnosis .

Objective To explore the characteristics of branch pulmonary artery flow patterns in fetuses with left heart hypoplasia syndrome (HLHS).Methods HLHS fetuses were divided into an unobstructed group and an obstructed group according to the blood flow pattern across the interatrial septum.Main pulmonary artery diameter,right pulmonary artery diameter,and Doppler parameters of first-order right pulmonary artery of both groups were measured by fetal echocardiography and compared with those of normal controls.Results There was a significant difference in the diameter of pulmonary trunk among different the three groups (F=198.56,P ＜ 0.05),and the main pulmonary artery diameter in the two groups of HLHS fetuses were larger than that in normal controls (t=-18.501,-13.97,P ＜ 0.05),but there was no significant difference between the two groups of HLHS fetuses (P=0.85).There was no significant difference in right pulmonary artery diameter among the three groups (P=0.59).The end-diastolic velocity,time-averaged maximum velocity,and velocity-time integral in the two HLHS groups were lower than those in normal controls,and these parameters in the obstructed group were less than those in the unobstructed group.The pulmonary artery pulsatility index in the two HLHS groups was higher than those in normal controls,and it was higher in the obstructed group than in the unobstructed group.There was no statistically significant difference in peak systolic velocity among the three groups (P=0.34).Conclusion The antegrade resistance of the pulmonary arteries of HLHS fetuses increase and these pathologcial conditions are more obvious in those with obstructed flow across the atrial septum compared to those with unobstructed flow.

Objective To explore the flow chart and key points of etiological differential diagnosis of character"卜"sign in fetal three-vessel and trachea(3VT)view.Methods A retrospective study was performed on ultrasound images of 37 fetuses,who had"卜"sign in 3VT view during fetal heart ultrasound scanning in The Affiliated Suzhou Hospital of Nanjing Medical University from Aug.2020 to Oct.2023.The types of diseases with"卜"sign and the flow chart and key points of differential diagnosis were summarized.All cases were diagnosed by 2 experienced senior prenatal ultrasound doctors independently.Results The incidence of"卜"sign was 0.14％(37/27 019).Among the 37 fetuses with"卜"sign on 3VT view,13(35.14％)cases had complete transposition of great arteries(TGA),11(29.73％)had double outlet of right ventricle with abnormal relationship of great arteries(DORV/AA),7(18.92％)had truncus arteriosus(TA,van Praagh A1,A2 and A3),and 6(16.22％)had pulmonary atresia with ventricular septal defect(PA/VSD).During the process of differential diagnosis,the presence or absence of aorta and pulmonary arteries,the ventricle-artery connection relationship,and the blood supply to both lungs should be focused on,and the final diagnosis can be derived step by step according to the flow chart.The key points of differential diagnosis were as follows:the ventricle-artery connection was inconsistent in TGA;in DORV/AA both aorta and pulmonary artery were entirely or mostly from right ventricle without normal spiral relationship;in TA only a common artery trunk was detected,and main pulmonary artery or its branches were from the artery trunk;and in PANSD pulmonary artery was atresia and only aorta was detected,and the blood supply to both lungs was from ductus arteriosus and/or aortopulmonary collateral arteries.Conclusion The fetal differential diseases with"卜"sign in 3VT view include TGA,DORV/AA,TA(van Praagh A1,A2 and A3),and PA/VSD.Understanding the flow chart and key points of differential diagnosis can improve the prenatal detection rate and diagnosis of related malformations.