Binh Thanh Tran

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.

Mục tiêu: Đánh giá một số đặc điểm tổn thương ở bệnh nhân (BN) vết thương thấu ngực điều trị tại Bệnh viện Quân y 103. Phương pháp nghiên cứu: Nghiên cứu mô tả, hồi cứu kết hợp với tiến cứu, không nhóm chứng trên 47 BN vết thương thấu ngực được điều trị tại Bệnh viện Quân y 103 từ tháng 01/2021 - 5/2025. Kết quả: Tổng số 47 BN, tuổi trung bình là 31,6 ± 12,2; trẻ nhất là 14 tuổi, lớn nhất là 58 tuổi; tỷ lệ nam giới là 97,9%. Có 55,3% BN chưa được sơ cứu gì trước khi đến viện, trong đó có 6 BN bị sốc. 91,5% BN bị thương do vật sắc nhọn, trong đó có 3 BN tự sát. Có 14 BN (29,7%) bị thương có xét nghiệm nồng độ cồn trong máu cao. Vết thương chủ yếu ở bên trái (80,9%), gây ra nhiều tổn thương, trong đó phổi và màng phổi là cơ quan thường gặp tổn thương nhất. Kết luận: Vết thương thấu ngực chủ yếu do vật sắc nhọn gây ra, đa số gặp ở nam giới trong độ tuổi lao động, nhiều trường hợp có xét nghiệm nồng độ cồn trong máu cao. Cắt lớp vi tính (CLVT) lồng ngực là xét nghiệm có độ chính xác cao trong chẩn đoán các tổn thương. Tổn thương trong vết thương thấu ngực rất đa dạng, trong đó phổi và màng phổi là cơ quan thường gặp tổn thương nhất.

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.

Primary pericardial mesothelioma is an exceedingly rare malignancy with poor progno-sis. The nonspecific symptomatology frequently impedes early diagnosis, leading to therapeutic challenges. We present a case of primary pericardial mesothelioma success-fully managed through surgical intervention, with the patient demonstrating clinical sta-bility at 15-month follow-up, significantly exceeding the typical survival duration report-ed in the literature.