Vinh Duc An Bui

Background: Giant left atrium is a rare complication of chronic rheumatic mitral valve disease. We report an extreme case to highlight the technical challenges and clinical considerations in the surgical management of this uncommon condition. Case presentation: A 46-year-old woman with rheumatic mitral valve disease, permanent atrial fibrillation, and right heart failure presented with dysphagia and hoarseness. Computed tomography showed a left atrial anteroposterior diameter of 167 mm and a computed volume of 2,225 to 2,411 mL, among the largest ever documented. She underwent mitral valve replacement, tricuspid annuloplasty, and left atrial plication. Surgery was technically successful, with visible intraoperative reduction in atrial size and a subsequent decrease in cardiac silhouette on early postoperative chest radiography, but the patient died on postoperative day 12 from refractory low cardiac output and drug-resistant ventilator-associated pneumonia. Conclusions: This case illustrates an extreme presentation of giant left atrium associated with rheumatic mitral valve disease. Although surgical reduction was technically feasible, careful patient selection and preoperative optimization remain crucial in patients with advanced right heart failure and low physiological reserve.

Background: Ventricular septal defect (VSD) is the most common congenital heart anomaly requiring surgical intervention. While median sternotomy remains the conventional approach, minimally invasive techniques through right axillary thoracotomy have emerged as viable alternatives offering superior cosmetic outcomes. This study aimed to evaluate the safety, feasibility, and early outcomes of VSD closure through minimally invasive right vertical axillary thoracotomy at our institution. Methods: A prospective descriptive study was conducted on 33 consecutive pediatric patients who underwent VSD closure through right vertical axillary thoracotomy at Hue Central Hospital from January 2025 to December 2025. Patients with isolated VSD (diameter ≥ 4 mm) were included. Patient demographics, operative parameters, postoperative outcomes, and echocardiographic follow-up data were collected and analyzed. Results: The study included 33 patients with a mean age of 28.0 ± 30.0 months (range: 1-97 months). VSD types were perimembranous (48.5%) and infundibular (51.5%). All procedures were completed without conversion to sternotomy. Mean cardiopulmonary bypass and aortic cross-clamp times were 49.2 ± 9.1 and 31.7 ± 7.9 minutes, respectively. There was no mortality, no complete heart block, and minimal complications (pneumonia 3.0%, pneumothorax 3.0%). Complete VSD closure was achieved in 87.9% at discharge, improving to 90.6% at one-month follow-up. Pulmonary artery pressure significantly decreased from 39.7 ± 18.5 mmHg preoperatively to 25.6 mmHg at follow-up. Conclusion: Minimally invasive VSD closure through right vertical axillary thoracotomy is a safe and effective approach with excellent early outcomes. The technique is applicable across a wide age spectrum and for both perimembranous and infundibular VSDs, offering substantial cosmetic advantages for pediatric patients.

Background: Compromised left ventricular function presents unique challenges during mitral valve surgery. Recent evidence suggests that subvalvular apparatus preservation might enhance postoperative recovery in high-risk populations. Methods: This prospective observational investigation (Hue Central Hospital, March 2015–September 2016) evaluated 87 patients undergoing mechanical mitral valve replacement with posterior leaflet preservation. Participants were stratified into two groups: reduced ejection fraction (EF ≤ 50%, n = 38) and preserved EF (>50%, n = 49). Comprehensive clinical and echocardiographic assessments were conducted at 1, 3, 6, and 12 months postoperatively. Statistical analysis employed parametric and non-parametric methodologies, with survival analyzed via Kaplan–Meier techniques. Results: The reduced EF cohort demonstrated significant improvement in contractile performance from 48.8 ± 5.2% preoperatively to 61.6 ± 7.2% at 12 months (p < 0.05). Ventricular dimensions decreased notably from 59.2 ± 6.6 mm to 47.6 ± 4.0 mm (p < 0.05). Hospital mortality was 2.3% (2 patients). Twelve-month survival rates reached 94.66% and 97.96% for reduced and preserved EF groups, respectively, without significant inter-group differences (p = 0.42). All surviving participants achieved functional status in NYHA class I or II. Conclusions: Mechanical mitral valve replacement with posterior leaflet preservation represents an effective approach for patients with reduced ventricular performance, promoting substantial improvement in cardiac function and excellent clinical outcomes.

Background: Pulmonary hypertension is common in left-sided heart valve disease, with historical studies reporting mortality rates up to 31% in severe cases undergoing mitral valve surgery. This study evaluates the impact of severe pulmonary hypertension on outcomes of mechanical mitral valve replacement with posterior leaflet preservation by comparing results with patients having mild-to-moderate pulmonary hypertension. Methods: Prospective analysis of 86 patients with mitral valve disease undergoing mechanical valve replacement with posterior leaflet preservation from March 2015 to September 2016 was conducted. Patients were stratified by pulmonary artery pressure: severe (≥60 mmHg, n = 19) versus mild–moderate (35–59 mmHg, n = 67). Primary outcomes included mortality, complications, and functional recovery at 1, 6, and 12 months. Results: The cohort included 67 patients (77.9%) with mild–moderate pulmonary hypertension and 19 patients (22.1%) with severe pulmonary hypertension. Severe pulmonary hypertension patients demonstrated higher NYHA functional class (73.7% class III vs. 46.2%, p = 0.03), larger left atrial diameter (56.3 ± 9.8 vs. 49.5 ± 6.7 mm, p = 0.01), and higher mean pressure gradients (14.4 ± 5.3 vs. 11.3 ± 5.0 mmHg, p = 0.025). Mortality was 5.3% in the severe group versus 0% in the mild–moderate group (p = 0.331). Patients with severe pulmonary hypertension required longer ICU stays (6.3 ± 3.7 vs. 4.7 ± 2.2 days, p = 0.024) but showed no significant differences in ventilation time, reoperation rates, or major complications. At the 12-month follow-up, both groups achieved equivalent outcomes in pulmonary artery pressures, left ventricular function, and cardiac dimensions. Conclusion: In this study with a relatively small sample size, severe pulmonary hypertension was associated with significantly longer intensive care unit stay but not with higher mortality compared to mild–moderate pulmonary hypertension, with both groups attaining comparable functional and hemodynamic parameters at 12 months after mechanical mitral valve replacement with posterior leaflet preservation.

Background: ALCAPA (Anomalous Left Coronary Artery from the Pulmonary Artery) is a rare congenital heart defect that, if left untreated, can lead to myocardial infarction, early heart failure, and death within the first year of life. Methods: We present a clinical case of an infant diagnosed with ALCAPA and undergoing surgical restoration of the coronary system, together with a literature review. Case report: A 3-month-old infant was initially admitted with a diagnosis of fulminant myocarditis and received intensive care. After hemodynamic improvement, echocardiography and computed tomography confirmed ALCAPA with moderate mitral regurgitation. The patient underwent direct reimplantation of the left coronary artery into the aorta. Postoperative recovery was favorable, with hospital discharge after 2 weeks. At 6-month follow-up, left ventricular ejection fraction was 66% and mitral regurgitation was mild. Conclusion: ALCAPA carries a high risk of mortality and can easily be misdiagnosed as myocarditis, highlighting the need for early recognition and timely treatment. Surgery remains the standard of care, with direct reimplantation of the left coronary artery into the aorta being the preferred technique when anatomy is favorable.

Introduction: This study evaluates the short-term and mid-term outcomes of aortic arch debranching combined with thoracic endovascular aortic repair (TEVAR) in thoracic aortic disease management.Methods: In this retrospective analysis, 45 patients diagnosed with thoracic aortic disease underwent a hybrid approach combining aortic arch debranching and TEVAR from 2017 to 2022.Results: Participants' average age was 64.6 years, with a male-to-female ratio of 3.1:1. The most frequent symptom was chest pain (71.1%). Surgery averaged 225.4 minutes, and intervention time was about 82.3 minutes. There were no deaths during surgery. Postoperative complications included 3 endoleak cases: a spontaneously resolved type I and one type III endoleak. The technical success rate stood at 95.6%. There were three in-hospital deaths, equating to a 6.7% mortality rate. The average follow-up was 29.35 months, with cumulative survival rates at 3, 12, and 24 months being 98%, 93%, and 93%, respectively.Conclusion: Combining aortic arch debranching with TEVAR effectively broadens treatment options for complex aortic arch and descending thoracic aortic diseases, showing promising short-term and mid-term results. Further research with longer follow-up and larger cohorts is advised for more extensive understanding.

Background: Compromised left ventricular function presents unique challenges during mitral valve surgery. Recent evidence suggests subvalvular apparatus preservation might enhance postoperative recovery in high-risk populations. Methods: This prospective observational investigation (Hue Central Hospital, March 2015-September 2016) evaluated 87 patients undergoing mechanical mitral valve replacement with posterior leaflet preservation. Participants were stratified into two groups: reduced ejection fraction (EF ≤50%, n=38) and preserved EF (>50%, n=49). Comprehensive clinical and echocardiographic assessments were conducted at 1, 3, 6, and 12 months postoperatively. Statistical analysis employed parametric and non-parametric methodologies, with survival analyzed via Kaplan-Meier techniques. Results: The reduced EF cohort demonstrated significant improvement in contractile performance from 48.8±5.2% preoperatively to 61.6±7.2% at 12 months (p<0.05). Ventricular dimensions decreased notably from 59.2±6.6mm to 47.6±4.0mm (p<0.05). Hospital mortality was 2.3% (2 patients). Twelve-month survival rates reached 94.66% and 97.96% for reduced and preserved EF groups, respectively, without significant inter-group differences (p=0.42). All surviving participants achieved functional status in NYHA class I or II. Conclusion: Mechanical mitral valve replacement with posterior leaflet preservation represents an effective approach for patients with reduced ventricular performance, promoting substantial improvement in cardiac function and excellent clinical outcomes.

Mục tiêu: điều trị viêm mủ màng phổi (VMMP) bao gồm kháng sinh, dẫn lưu màng phổi và can thiệp ngoại khoa. Tuy vậy thời điểm phẫu thuật tối ưu vẫn còn tranh cãi. Nghiên cứu đánh giá kết quả phẫu thuật bóc vỏ phổi trong điều trị VMMP và xác định mối liên quan giữa phân loại RAPID với kết quả điều trị ngoại khoa.Đối tượng, phương pháp: nghiên cứu hồi cứu, mô tả loạt ca 47 bệnh nhân (BN) VMMP phẫu thuật bóc vỏ phổi tại Bệnh viện Đại học Y Dược TP. Hồ Chí Minh từ 1/2019 đến 12/2023.Kết quả: Đau ngực là lý do nhập viện phổ biến (51,1%), nguyên nhân gây bệnh chủ yếu là viêm phổi (61,7%). 55,32% VMMP giai đoạn III. Đa số BN thuộc nhóm RAPID trung bình (63,8%). Phân loại RAPID có liên quan đến kết quả điều trị.. Nhóm RAPID trung bình – cao có thời gian nằm viện dài hơn (p<0,002) và nhiều biến chứng hơn so với nhóm RAPID thấp. Trong nhóm RAPID trung bình – cao, phẫu thuật sớm giúp giảm biến chứng so với phẫu thuật muộn (p<0,031). Tỷ lệ tử vong sau 3 tháng là 6,4%.Kết luận: Thang điểm RAPID giúp phân tầng nguy cơ và dự đoán kết quả điều trị ngoại khoa VMMP. Phẫu thuật sớm có thể mang lại lợi ích cho bệnh nhân RAPID trung bình – cao.