Objective·To analyze the neurodevelopmental outcomes of children after end-to-side anastomosis for coarctation of the aorta(CoA).Methods·The surgical and neurological follow-up data were collected from children who underwent end-to-side anastomosis for CoA at Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine from January 1,2017 to December 31,2021.Neurological assessments included magnetic resonance imaging(MRI)and Griffiths Mental Development Scale assessments.Neurodevelopmental outcomes were evaluated using Griffiths Mental Development Scale.Clinical characteristics were compared between patients with normal and abnormal MRI and Griffiths Mental Development Scale results to assess the correlation between the two assessments and their association with cardiopulmonary bypass(CPB)use and CPB modality.Results·Twenty-seven children with isolated CoA or CoA combined with simple intracardiac anomalies were included.MRI results were available for 25 cases,with 5 showing abnormalities(20.0%).Griffiths Mental Development Scale results were available for 26 cases,with 21(80.77%)showing abnormal scores,including 18 in hearing and language,and 12 in performance.No significant correlation was found between abnormal MRI or Griffiths Mental Development Scale results and the use of CPB(P=0.341,P=1.000).Among patients who underwent CPB,those in the moderate hypothermia group accounted for the majority of cases without neurological abnormalities,with proportions of 80.00%(MRI)and 100.00%(Griffiths Mental Development Scale).Conclusion·Children undergone end-to-side anastomosis for CoA are at relatively high risk for neurodevelopmental abnormalities,particularly in hearing-language and performance domains.CPB may not be a direct risk factor for poor neurodevelopmental outcome,and moderate hypothermia during CPB may be neuroprotective.

Objective·To analyze the neurodevelopmental outcomes of children after end-to-side anastomosis for coarctation of the aorta(CoA).Methods·The surgical and neurological follow-up data were collected from children who underwent end-to-side anastomosis for CoA at Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine from January 1,2017 to December 31,2021.Neurological assessments included magnetic resonance imaging(MRI)and Griffiths Mental Development Scale assessments.Neurodevelopmental outcomes were evaluated using Griffiths Mental Development Scale.Clinical characteristics were compared between patients with normal and abnormal MRI and Griffiths Mental Development Scale results to assess the correlation between the two assessments and their association with cardiopulmonary bypass(CPB)use and CPB modality.Results·Twenty-seven children with isolated CoA or CoA combined with simple intracardiac anomalies were included.MRI results were available for 25 cases,with 5 showing abnormalities(20.0%).Griffiths Mental Development Scale results were available for 26 cases,with 21(80.77%)showing abnormal scores,including 18 in hearing and language,and 12 in performance.No significant correlation was found between abnormal MRI or Griffiths Mental Development Scale results and the use of CPB(P=0.341,P=1.000).Among patients who underwent CPB,those in the moderate hypothermia group accounted for the majority of cases without neurological abnormalities,with proportions of 80.00%(MRI)and 100.00%(Griffiths Mental Development Scale).Conclusion·Children undergone end-to-side anastomosis for CoA are at relatively high risk for neurodevelopmental abnormalities,particularly in hearing-language and performance domains.CPB may not be a direct risk factor for poor neurodevelopmental outcome,and moderate hypothermia during CPB may be neuroprotective.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.

Objective:To summarize the prenatal ultrasonographic features and prognosis of fetal umbilical-portal-systemic venous shunt (UPSVS).Methods:This retrospective study retrieved the records of 14 fetuses with UPSVS from Chongqing Health Center for Women and Children from January 2018 to September 2020, to describe their ultrasonographic features, concomitant malformations, chromosomal examination results, and follow-up.Results:All the 14 cases were classified into three types: Type Ⅰ ( n=2), the umbilical vein directly connected to the systemic venous detouring around the liver; Type Ⅱ ( n=2), the umbilical vein connected to the distal inferior vena cava instead of the left atrium after entering the liver through the ductus venosus; and Type Ⅲa ( n=10), those with an intrahepatic shunt, between the intrahepatic portal venous system and the hepatic vein. Of the 14 fetuses, 11 had normal chromosome test results, including four had serum screening of Down syndrome in the first trimester, four had non-invasive prenatal testing, and three had prenatal genetic diagnosis. Six cases were complicated by other system malformations. Fetal growth restriction and heart failure were found in four cases each. Four pregnancies were terminated due to other anomalies and the other 10 ended in live births with good prognosis for the fetuses. Conclusions:Special attention should be paid to the fetal umbilical- portal-venous system when there are unexplained fetal growth restriction, fetal heart failure, or abnormal blood vessels in the abdominal section of the fetus. UPSVS has typically ultrasonographic features, which can prenatally determine the shunt type and the integrity of the intrahepatic portal venous system. A full assessment of the intrauterine fetal condition and other malformations are of great value in prognostic counseling.

Objective:To explore the value of prenatal MRI in assessing the cardiovascular structure and brain development of fetuses with tetralogy of Fallot (TOF).Methods:From August 2011 to April 2021, 30 fetuses of TOF with gestational age (GA) 18-33 (25±3) weeks were retrospectively enrolled in Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University. Sixty normal fetuses were selected with matched GA of TOF fetuses as control group. In 30 fetuses with TOF, the GA of 17 fetuses were less than 25 weeks and of 13 fetuses were more than 25 weeks. The balanced fast field echo sequence MRI was performed to measure the diameter of the aortic arch isthmus (AoI), the main pulmonary artery (MPA) and the ratio was calculated (MPA/AoI). The size of ventricular septal defect (VSD) was measured in TOF group. The single-shot turbo spin echo sequence MRI was performed to measure fetal brain biparietal diameter (BBD), brain frontal-occipital length (BFOL), skull biparietal diameter (SBD), skull fronto-occipital diameter (SOD) and head circumference (HC). The Pearson analysis was used to evaluate the correlation of the above indicators with GA. The independent sample t test was used to compare the differences in various indicators between TOF and control groups in both GA≤25 and GA>25 weeks. Results:The sizes of VSD in TOF fetuses were (3.5±1.1) mm (GA≤25 weeks) and (4.4±0.6) mm (GA>25 weeks). The AoI, MPA, BBD, BFOL, SBD, SOD, HC were positively associated with GA (TOF group: r=0.80, 0.50, 0.92, 0.93, 0.91, 0.84, 0.91, MPA P=0.005, others all P<0.001; control group: r=0.90, 0.87, 0.96, 0.95, 0.93, 0.95, 0.96, all P<0.001). For fetuses with GA≤25 weeks, there were 17 fetuses in TOF group and 34 fetuses in control group, and the AoI in TOF group was larger than that in control group ( t=10.00, P<0.001), the MPA, MPA/AoI, BFOL were smaller than those in control group (all P<0.05). No statistical significant differences of BBD, SBD, SOD, HC were found between the groups (all P>0.05), For fetuses with GA>25, there were 13 fetuses in TOF group and 26 fetuses in control group, and the AoI in TOF group was larger than that in control group ( t=3.36, P=0.002) and MPA, MPA/AoI, BBD, BFOL, SOD, HC were smaller than those in control group (all P<0.05). No statistically significant difference of SBD was found between groups ( P=0.068). Conclusions:MRI is feasible to measure the cardiovascular structure and the brain development of fetuses with TOF. Fetuses with TOF have varying degrees of VSD, MPA stenosis and AoI dilation. An altered brain growth of fetuses with TOF appears in the second trimester of pregnancy.

This paper reported a male newborn with Ebstein's anomaly complicated by type B Wolff-Parkinson-White syndrome. The baby was delivered at 39 weeks of gestation and diagnosed as Ebstein's anomaly complicated by type B Wolff-Parkinson-White syndrome 2 d after birth. He was improved and discharged after conservative management in the Department of Internal Medicine. No abnormality was found by fetal echocardiography at 20 weeks of gestation, while supraventricular tachycardia was diagnosed by M-mode ultrasonography at 38 weeks of gestation due to rapid fetal heart rate. In addition to hemodynamic changes,the abnormal cardiac structure in patients with Ebstein's anomaly may also lead to tachyarrhythmia. Therefore, in fetuses diagnosed with supraventricular tachycardia by prenatal ultrasound or children with type B Wolff-Parkinson-White syndrome detected by electrocardiogram after birth, tricuspid valve should be carefully scanned under echocardiography to avoid the missed diagnosis of Ebstein's anomaly.

Objective:To investigate the feasibility of MRI measurement for normal fetal aortic arch isthmus diameter and ductus arteriosus diameter between 20 to 36 weeks of gestation and analyze its relationship with gestational age.Methods:This retrospective study enrolled 257 pregnant women with an unclear fetal four-chamber view in prenatal ultrasonography, whose following fetal MRI examination results showed no structural cardiac abnormalities, in Shanghai Children's Medical Center Affiliated to the Medical College of Shanghai Jiaotong University from June 2018 to June 2020. Postnatal echocardiography confirmed cardiac structures were normal in all cases. MRI images were reviewed to measure the diameter of the aortic arch isthmus, defined as the aortic arch isthmus's central diameter, in the transverse section of the aortic arch in steady-state free precession sequence imaging and the diameter of ductus arteriosus near the descending aorta. The average values were calculated after repeating each measurement three times. The 5th, 50th and 95th percentiles and their 95% CI of the aortic arch isthmus diameter and the ductus arteriosus diameter corresponding to different gestational age and the mean value and its 95% CI of the ratio of the aortic arch isthmus diameter to the ductus arteriosus diameter were calculated. Pearson correlation analysis and regression analysis were used to evaluate the relationship of the aortic arch isthmus diameter and the ductus arteriosus diameter with gestational age. Results:The regression equation between the aortic arch isthmus diameter and gestational age was as follows: the aortic arch isthmus diameter (mm) =-2.85+0.22×gestational age (weeks), and there was a positive linear correlation between them ( R2=0.737, P<0.001). The 50th percentile of the aortic arch isthmus diameter was 1.8-3.5 mm at 20-28 weeks and 3.5-5.0 mm at 28-36 weeks. The regression equation between the diameter of ductus arteriosus and gestational age was as follows: the diameter of ductus arteriosus (mm) =-2.17+0.19×gestational age (weeks), and a positive linear correlation between them was revealed ( R2=0.606, P<0.001). The 50th percentile of the diameter of ductus arteriosus was 2.0-3.5 mm at 20-28 weeks and 3.2-4.8 mm at 28-36 weeks. The 95% CI for the ratios of the aortic arch isthmus diameter to the ductus arteriosus diameter at 20, 22, 24, 26, 28, 30, 32, 34 and 36 weeks of gestation were 0.8-1.1, 0.8-1.0, 0.8-1.0, 0.8-1.3, 0.8-1.5, 0.9-1.5, 0.9-1.7, 0.9-1.1 and 1.0-1.3, respectively, and were all close to 1. Conclusions:It is feasible to measure fetal aortic arch isthmus diameter and ductus arteriosus diameter at 20-36 weeks of gestation in MRI, and both measurements have a linear correlation with gestational age.

Human fetal heart is the difficulty in ultrasound standardized resident training, which involves embryogenesis, anatomy, fetal circulation characteristics, the mechanism of cardiac malformation and the points of ultrasonic diagnosis. This study investigated the application of missed and misdiagnosed case analysis in fetal heart teaching in ultrasound standardized resident training. The teacher selected the missed and misdiagnosed cases according to the teaching purpose, the students subsequently discussed, analyzed and reported the causes of missed and misdiagnosed cases, then the teacher combed and explained the key knowledge and extended knowledge points. According to the questionnaire survey, the students agreed that the analysis of missed and misdiagnosed cases can mobilize the enthusiasm of learning, help to understand the knowledge, and guide the future clinical work.

Objective:To investigate the prenatal ultrasonic characteristics and hemodynamic changes of umbilical artery (UA) thrombosis in fetus, and to improve the accuracy of prenatal ultrasound diagnosis.Methods:The prenatal sonographic features and hemodynamic index of 5 cases with umbilical artery thrombosis(UAT) in Chongqing Health Center for Women and Children from January 2018 to April 2020 were analyzed and summarized retrospectively.Results:The absence of blood flow in one of the two UA was found in the third trimester of pregnancy while two UA were displayed in previous ultrasound scans and the blood flow of the UA on the right side of the bladder disappeared in 5 cases. The umbilical cord cross section showed three cavities in 5 cases. The long axis section of the umbilical cord showed hyperecho in one UA with no blood flow in 4 cases, and no exact hyperecho in the UA only showed no blood flow in 1 case. The UA systolic/diastolic velocity ratio(S/D)<2.0 and UA pulsatility index (PI)<5 th were observed in 5 cases. The middle cerebral artery (MCA) PI<5 th in 4 cases and 10 th

Objective: To analyze the feasibility of prenatal ultrasound quantitative measurement of the angles between trachea and bilateral bronchi as a new diagnostic tool for fetuses with heterotaxy syndrome. Methods: The angles between trachea and bilateral bronchi were measured at 18-34⁺⁶ gestational weeks for 200 fetuses with normal ultrasound findings (normal group) and 41 fetuses with heterotaxy syndrome [35 right atrial isomerisms (right group) and six left atrial isomerisms (left group)] diagnosed by ultrasound and confirmed after abortion or induction (case group) in Chongqing Health Center for Women and Children from October 2015 to December 2018. Scatter plots of left/right bronchus angle (α/β) ratios were drawn. Differences in bilateral bronchus angles between the three groups were statistically analyzed using one-way analysis of variance and paired t-test. Results: In the normal group, scatter plots showed the α/β ratios were relatively constant at 0.8-1.0 with larger β than α (t=-33.14, P<0.05), indicating that the right bronchus always went more steeply than the left one. In the case group, the α/β ratios were around 1.0. In the right group, the α value increased and was close to the β value [(153.90±5.43)° vs (156.02±5.59)°, t=-2.56, P>0.05] and presented as bilateral right bronchial angle; in the left group, the β value decreased and was close to the α value [(147.38±3.16)° vs (148.82±5.56)°, t=-1.18, P>0.05] and presented as bilateral left bronchial angle. There were significant differences in the α and β values among the normal group, the right and left groups (all P<0.05), and the bronchial angles of the right group were both greater than those of the left group (all P<0.05). Conclusions Prenatal ultrasound measurement of the angles between trachea and bilateral bronchi can be used as an indirect indicator for the diagnosis of heterotaxy syndrome.