Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam

Ruptured sinus of Valsalva aneurysm: 115’Hospital experience and the concise review of the literature

Le Huu Dung — 2025-07-10

OBJECTIVES: Sinus of Valsalva aneurysms are rare cardiac anomalies and more common in Eastern than in Western populations, surgery is the most common option of treatment for ruptured sinus of Valsalva aneurysm (RSVA) To examine demographic information, clinical presentation, results, and long-term effects of surgically repairing sinus of Valsalva aneurysm (SVA), a retrospective study was conducted. METHODS: We looked back at the data of 26 individuals who had their ruptured sinus of Valsalva aneurysm treated between May 2007 and December 2018 and overview of the literature on RSVA instances that have been reported in PubMed. RESULTS: Following the original repair, there was no mortality. At five years, the actuarial survival rate was 92.3%.

Case Report: Treatment of Infected Femoral Artery Pseudoaneurysm (IFAP) in a High-Risk Female Patient

Nguyen Anh Dung — 2025-07-10

Abstract: Infected femoral artery pseudoaneurysm (IFAP) is a rare but potentially life-threatening vascular condition. Its management poses significant challenges, especially in patients with complex comorbidities. We present a case of a 66-year-old female patient diagnosed with an infected pseudoaneurysm of the left superficial femoral artery (SFA), with a background of obesity, type 2 diabetes mellitus, hypertension, dyslipidemia, and Cushing’s syndrome secondary to long-term corticosteroid use. The patient underwent a staged treatment strategy, including initial endovascular exclusion of the aneurysm with a covered stent, surgical abscess debridement with negative pressure wound therapy (VAC system), and subsequent femoropopliteal bypass using an in-situ great saphenous vein graft. Outcome: The patient achieved full recovery without signs of limb ischemia at the 12-month follow-up. This case illustrates that a combined endovascular and surgical approach may be an effective and limb-preserving strategy for managing IFAP in high-risk patients with multiple comorbidities.

Results of surgical treatment for chronic pulmonary aspergillosis at the National Lung Hospital 2023-2024

Pham Thi Thanh Dua — 2025-07-10

Introduction: Chronic pulmonary Aspergillosis (CPA) is a condition where Aspergillus infection invades and develops chronically, gradually destroying lung structures. Surgical intervention is indicated for most patients with localized fungal lesions and severe, persistent, life-threatening hemoptysis. This study aims to evaluate the outcomes of surgical treatment for chronic pulmonary Aspergillosis at the National Lung Hospital from 2023 to 2024. Methods: This was a retrospective, cross-sectional descriptive study. It included 124 patients diagnosed with chronic pulmonary Aspergillosis who underwent surgical treatment at the National Lung Hospital from January 2023 to June 2024. Data were analyzed using Stata software. Results: Among 124 patients with chronic pulmonary Aspergillosis, 115 cases received conventional surgery and 9 underwent emergency surgery. There were 72 male patients (58.1%) and 52 female patients (41.9%). The average age was 53±14 years. The primary clinical symptom was hemoptysis (75.8%). The most common co-morbid lung disease was pulmonary tuberculosis, affecting 59 patients (47.6%). Lobectomy was the most frequent indication for moderate to severe hemoptysis, accounting for 85.7% of cases. The median duration of drainage was 5-6 days, and the median hospital stay was 8-12 days. The complication rate was under 10%, and the success rate was 98.28%. Four severe cases requested discharge. Conclusion: Surgical treatment for chronic pulmonary Aspergillosis is considered to have acceptable complication rates and should be performed in in specialised centres with experienced surgeons to manage and treat chronic pulmonary Aspergillosis, helping patients achieve complete recovery and improved quality of life without symptoms.

Surgical outcomes of peripheral vascular trauma in pediatric patients at the Cardiovascular and Thoracic Center, Viet Duc University Hospital

Vu Xuan Hiep — 2025-07-10

Objective: To describe the diagnostic features, surgical methods, and outcomes of peripheral vascular injury management in pediatric patients. Methods: A retrospective cross-sectional study was conducted on all patients under 16 years of age who underwent surgery with an intraoperative diagnosis of peripheral vascular injury due to trauma (including vasospasm, vascular contusion, and thrombosis) at the Cardiovascular and Thoracic Center, Viet Duc University Hospital, from January 2021 to December 2024. Results: Among the 35 pediatric patients, 23 (65.7%) sustained upper limb injuries, while 12 (34.3%) had lower limb injuries. The predominant mechanism of trauma was domestic accidents (primarily unassisted falls), accounting for 24 cases (68.5%), followed by traffic accidents (n = 10, 28.6%) and one case (2.9%) of occupational injury. All patients had at least one limb fracture, including 26 closed fractures (74.3%) and 9 open fractures (25.7%). A total of 30 patients (85.7%) showed no signs of acute ischemic syndrome. Regarding treatment, intraoperative pathological findings suggestive of vascular spasm were observed in 27 cases (77.1%). Among them, five patients (14.3%) received topical papaverine to induce vasodilation, while 22 (62.9%) required arterial dilatation using a Fogarty catheter. Four patients (11.4%) with arterial contusions were treated with end-to-end anastomosis, and another four (11.4%) underwent vascular reconstruction using reversed saphenous vein grafts. One patient (2.9%) developed postoperative complications, including infection and thrombosis, requiring reoperation and vascular repair using a saphenous vein homograft. Conclusion: Vascular trauma presents significant challenges in pediatric cases. Vascular surgeons must consider the patient’s future growth potential when planning interventions. Early diagnosis and timely treatment by experienced vascular surgeons at high-volume surgical centers can help reduce mortality and limb amputation rates.

Role of endovascular intervention in femoral artery trauma

Nguyen Thanh Hung — 2025-07-10

Abstract: Femoral artery trauma is one of the most frequently encountered vascular injuries in trauma centers worldwide, accounting for 70% of all recorded peripheral vascular injurie. These represent critical medical emergencies, typically arising from traffic accidents, occupational incidents, injuries from sharp objects, or iatrogenic trauma during medical procedures[1]. Recent advances in endovascular intervention techniques have revolutionized the management of vascular trauma, offering minimally invasive alternatives alongside traditional open surgical repair. However, further research is needed on long-term outcomes and patient selection criteria to optimize the use of these techniques.

Midterm results of totally endoscopic mitral valve replacement via right minithoracotomy at Hanoi Heart Hospital

Pham Vu Dang Minh — 2025-07-10

This was a cross- sectional study included 121 patients with mean age of 57 ± 9.2 years (35 - 75), 80.2% of patients was women. All patients had heart failure classified by NYHA as moderate to severe, with 66.9% falling into NYHA classes 3-4. Surgical statistics showed: Mean aortic clamping time: 75,3 ± 24,6 minutes (35 – 191), mean cardiopulmonary bypass time: 125,7 ± 36,8 minutes (62 – 297), operative time: 199,3 ± 52,7 minutes (120 – 390), mean ventilation time was 14.4 ± 13.9 hours. 94.2% of patients were extubated within 24 hours. Mean ICU stay time was 2.8± 1.3 days (1-10), and mean hospital stay time was 11.4 ± 4.4 days (6-28). Pneumonia was the most common posoperative complication, occurring in 7 patients (5.7%). Other complications included: Venous perforation: 1 patient (0.8%), cognitive dysfunction: 2 patients (1.7%), stroke: 1 patient (0.8%), chest wall bleeding requiring reoperation: 2 patients (1.7%), pericardial effusion requiring drainage: 1 patient (0.8%), chest wound infection: 2 patients (1.7%), in-hospital mortality 0% .

A case report: catecholamine-secreting adrenal tumor-inducing cardiomyopathy

Nguyen Ngoc Tan — 2025-07-10

Introduction: Catecholamine-secreting adrenal tumors (pheochromocytoma/paraganglioma) are rare neoplasms causing paroxysmal hypertension, metabolic disturbances, and cardiomyopathy. Diagnosis relies on biochemical tests (plasma-free metanephrines) and imaging (CT/MRI). Definitive treatment involves tumor resection with perioperative hemodynamic control. Case summary: A 47-year-old female with no prior hypertension presented with chest pain, hypertensive crisis (180/100 mmHg), hyperglycemia, and metabolic acidosis. Elevated norepinephrine (312.33 pg/mL) and abdominal MRI confirmed a right adrenal tumor (22×22×20 mm). A surgical resection was performed. Postoperatively, blood pressure normalized, and cardiac function improved (EF increased from 47% to 70% at the 2-month follow-up). Conclusion: Catecholamine-secreting tumors may induce severe cardiomyopathy even without a hypertension history. Early diagnosis and prompt surgery are critical for cardiac recovery and preventing complications.

Series case report of efficacy and safety of radiofrequency catheter ablation to treat atrial tachycardia originating from the distal portion of the atrial appendage

Pham Van Tung — 2025-07-10

Objective: Our case series report aims to investigate the efficacy and safety of radiofrequency catheter ablation (RFCA) to terminate atrial tachycardia (AT) originating from the distal portion of the atrial appendage. Material and methods: Three-dimensional electroanatomic mapping (3-DEAM) systems (CARTO and Ensite Precision) were used in our study in two cases to create map and assess the anatomic location. Clinical features and electrocardiographic (ECG) characteristics were analyzed. We perform our ablations by using a infusing -cold saline and contact force sensing catheter at the appendages targeting loci of atrial tachycardia (AT) origin under the guidance of the 3-DEAM system. The curative effect and safe were evaluated. Results: The ages of the two patients were 23 and 61 years old. With case 1, we found that the AT origin was from the right atrial appendage (RAA) and with case 2, we found that the AT origin was from the left atrial appendage (LAA). The ECG characteristics of AT from the RAA were as follows: (1) negative P waves in chest leads V1,V2; (2) positive P waves in peripheral leads II, III, aVF, D1, aVL. The ECG of the AT originated from LAA was characterized by: (1) positive P waves in chest leads V1,V2 and in inferior leads II, III, aVF but the P wave is obscured within the T wave. (2) P waves are isoelectric in leads DI; and (3) P waves are negative in lead aVL. Pre-operation echocardiography showed normal left ventricular ejection fraction (LVEF) and no thrombus in both cases. Radiofrequency ablation was successful in both patients. The earliest activation time of the successful RFA sites(the endpoint sites) was 34ms and 43ms before the onset of the P wave. There were no complications and long-term success was achieved in both patients during follow-up 23,5 months. Conclusions: We prove that the atrial tachycardia which origin was from the atrial appendages showed the characteristic P-wave manifestations on ECG and RFCA to treat AT originating from the distal portion of the atrial appendage was safe and effective during follow-up average 23,5 months.

Evaluation of Early Outcomes of Minimally Invasive Congenital Heart Surgery via Right Axillary Approach at the Heart Institute of Ho Chi Minh City

Pham Huu Minh Nhut — 2025-07-10

Background: At our Heart Institute, the right axillary approach has been chosen for minimally invasive cardiac surgery for congenital cardiac patients in both adults and children. Objective: we evaluate the results of minimally invasive congenital cardiac surgery via the right axillary approach at the Heart Institute of HCM City. Method: descriptive study, case series. Results: From 11/2022 to 08/2024, 123 patients with congenital heart defects underwent complete repair via the right axillary minimally invasive cardiac surgery. There were 93 ASD (75.5%), 17 VSD (13.8%), 11 partial or intermediate AVSD (8.9%) and 2 Cor Triatriatum (1.6%). Concomitant procedures included: 2 PDA ligation (1.6%), 2 pAPVD repairs (1.6%), 12 tricuspid valve repairs (9.5%), 1 mitral valve repair (0.8%), and 1 resection of subaortic stenosis (0.8 %). There was no hospital mortality, the median time of ICU stay was 1 day and the median time of hospital stay was 7 days. Conclusion: minimally invasive cardiac surgery via the right axillary approach could be applied for simple congenital heart defects safely with low morbidity.

Factors associated with health-related quality of life in pediatric patients after minimally invasive right axillary approach for ventricular septal defect repair at the Cardiovascular Center - E Hospital

Nguyen Thi Yen — 2025-07-10

Ventricular septal defect (VSD) is one of the most common congenital heart diseases in children. Surgical correction offers a complete repair of the defect without long-term sequelae. Minimally invasive surgery is a novel technique that ys many advantages to patients. Evaluating postoperative quality of life (QoL) also reflects the outcomes of this approach. Objective: To describe the health-related quality of life (HRQoL) and investigate associated factors in pediatric patients after VSD repair using a minimally invasive right axillary thoracotomy at the Cardiovascular Center - E Hospital. Subjects and Methods: A cross-sectional descriptive study was conducted on 47 children aged 2-12 years who underwent VSD repair via minimally invasive right axillary approach from December 2022 to July 2024. HRQoL was assessed using the Vietnamese version of the Pediatric Quality of Life Inventory™ 4.0 Generic Core Scale (based on parent interviews and medical record reviews). Data were collected at least one month after surgery. Results: The mean overall HRQoL score was 79.57 ÷ 7.13. Factors significantly associated with HRQoL included preoperative heart failure severity (Ross classification), parental education and employment status, and the child's school attendance (p < 0.05). Conclusion: Minimally invasive VSD repair via the right axillary approach provides favorable HRQoL outcomes. However, children with specific clinical and social risk factors require closer monitoring and support to improve postoperative quality of life.

Revisiting the diagnostic and prosnotic performance of cyfra 21-1 and cea in non small cell lung cancer

Vo Tuan Anh — 2025-07-10

Introduction: Non-small cell lung cancer (NSCLC), a leading cause of cancer mortality, is often diagnosed late, necessitating reliable biomarkers. Carcinoembryonic Antigen (CEA) and Cytokeratin 19 Fragment (CYFRA 21-1) show promise for early detection and prognosis in NSCLC, but their performance requires further validation. Methods: This retrospective study evaluated 135 patients at a tertiary hospital for lung cancer. Diagnostic performance of CEA and CYFRA 21-1 was assessed via Receiver Operating Characteristic (ROC) analysis, with subgroup analyses across histological subtypes. Survival was analyzed using Kaplan-Meier estimates and Cox proportional hazards models. Results: Of 135 patients, 95 had NSCLC (70.4%). ROC analysis showed moderate diagnostic accuracy for CEA (AUC: 0.78, 95% CI: 0.70–0.85; cut-off: 5.5 ng/mL, sensitivity: 72%, specificity: 68%) and CYFRA 21-1 (AUC: 0.82, 95% CI: 0.75–0.88; cut-off: 3.8 ng/mL, sensitivity: 78%, specificity: 70%). Subgroup analysis revealed CYFRA 21-1’s superior accuracy in squamous cell carcinoma (AUC: 0.87, sensitivity: 82%, specificity: 75%) and adenocarcinoma (AUC: 0.84), while CEA performed better in poorly differentiated carcinoma (AUC: 0.77). Elevated CEA (>5.5 ng/mL) and CYFRA 21-1 (>3.8 ng/mL) predicted worse survival (HR: 1.5, 95% CI: 1.1–2.0; HR: 1.7, 95% CI: 1.2–2.3), reducing median survival to 12 and 10 months from 20 and 22 months, respectively. Conclusion: CEA and CYFRA 21-1 enhance NSCLC diagnosis and prognosis, with histology-specific strengths, supporting their role in precision oncology.

The role of conservative surgery in the treatment of Papillar thyroid microcarcinoma at Thong Nhat Hospital

Nguyen Do Nhan — 2025-07-18

Background: Although very common and full of the dangers of cancer, many recent studies have noted that small papillary thyroid carcinoma progresses slowly and there are cases where conservative thyroidectomy gives good results even though it is not from the perspective of radical surgery. In Vietnam, there is currently little information on this issue. What are the results of surgical treatment in these cases?. Objectives and method: the descriptive cross-sectional study of 49 cases of small papillary thyroid cancer, evaluation of surgical results and mid-term follow-up from 01/2022 to 01/2025 at Thong Nhat Hospital. Results and discussion: The mean age was 45.1. The male/female ratio was 1/3.9(p=0.003). Multiple tumors were 22.4%. Tumors invading the capsule were 16.3%. Neck lymph node metastasis was 16.3%. There was no distant metastasis. Stage I according to cTNM was 91.8%. The total lobectomy and isthmus group had 34 cases; the total thyroidectomy group had 15 cases. In the two groups: hypothyroidism after 6 months of surgery was 36.7%, 30.6% (p=0.002); 12 months was 06.1%, 28.6% (p=0.001). In each group: total lobectomy with isthmus, postoperative hypothyroidism at 6 months and 12 months was 36.7% and 06.1% (p=0.002); Total thyroidectomy, the rate was 30.6% and 28.6% (p=0.52). 01 case of hoarseness, 01 thoracic duct rupture, 02 cases of tetany. There was no surgery-related death. Recurrence was 2% in 24-month follow-up. Conclusion: Microcarcinoma papillary thyroid cancer is mainly stage 1. Surgery gives good results. There is no surgery-related mortality. Hypothyroidism after total lobectomy is lower than total thyroidectomy and recovery after 12 months. low recurrence rate in 24 months follow-up.

Long-term results and evolution of mitral regurgitation after surgical treatment for Anomalous Left Coronary Artery from Pulmonary Artery at Ho Chi Minh City Heart Institute

Huynh Ngoc Thien — 2025-07-22

Background: Mitral regurgitation in anomalous left coronary artery from the pulmonary artery (ALCAPA) is secondary and caused by ischemia of papillary muscle. The study aimed to evaluate the long-term results of surgery and the evolution of mitral valve regurgitation after repair. Methods Retrospective review of all patients who underwent operation for ALCAPA with or without mitral repair at Ho Chi Minh City Heart Institute during the period 2000-2021. Result A total of 56 patients (male, 23; median age 1,67 y.o) were divided into two groups: infant ≤ 12 months (n= 25) and adults type(n=31 patients). Surgical reimplantation of the left coronary artery accounts for 43 cases for both groups. In group 2, Takeuchi’s procedure was 3 cases and left coronary bypass in 6 cases. In both groups, 33 cases required mitral valve repair, 4 cases required replacement and 19 cases did not required intervention the mitral valve. There were 3 operative deaths (all in group 1) and no late deaths. The mean follow-up time after surgery was 92.5 ± 56.6 months. Only one patient lost to follow-up.The 52 survivors all had LVEFs above 55-60%. Overall cumulative survival at 5, 10, and 20 years was 94.6 ± 3%. 6/33 cases with initial valve repair had to have re-operation due to recurrent valve regurgitation (3 months-19 years after the initial surgery). At the time of final follow-up, 30 patients have mild to moderate mitral regurgitation. 19 patients without mitral intervention did not significantly change the degree of mitral regurgitation. Freedom from all causes of re-operation at 5 and 15 years was 94.4 ± 4% and 82.6 ± 8.6%. Freedom from re-operation for evolutive mitral regurgitation at 15 years was 84.8 ± 1.06% (group 1) and 81.8 ±1.16% (group 2), P= 0,045. Conclusion Surgical treatment for ALCAPA gives good long-term results. Evolutive mitral regurgitation after mitral surgery is more common in adults than in the infant group and requires continued periodic monitoring in follow-up.

Echocardiographic characteristics of children under 16 years old with tetralogy of Fallot operated at Cho Ray Hospital

Le Thanh Khanh Van — 2025-07-25

Objective: Describe the echocardiographic characteristics of patients under 16 years old with tetralogy of Fallot before total repair surgery at Cho Ray Hospital. Subjects and methods: Describe retrospective case series of echocardiographic characteristics of children under 16 years old with tetralogy of Fallot before total repair surgery, from February 2023 to February 2024. Results: 23 patients were included in the study from February 2023 to February 2024. The median age of patients was 10.5 months (5 – 34.5). Female is 65.2%. Median weight is 7.8 kg (6 – 9.5). Median SpO2 was 80.0% (70.0 – 88.0). The small left ventricle accounted for a high proportion of 56.5%. Right ventricular dilatation at the base, mid, and long diameters accounted for 30.4%, 39.1% and 30.4%, respectively. 69.6%, 56.5%, 21.7%, 8.7% of patients had pulmonary valve ring, pulmonary trunk, right pulmonary artery, left pulmonary artery small, respectively. Medium and large membranous ventricular septal defect accounted for 65.2% and 34.8%, respectively. The median aortic overriding percentage of patients was 30.0% (30.0-45.0). 100.0% of patients had right ventricular hypertrophy. Most patients had stenosis at all three locations below the valve, at the valve, and above the pulmonary valve, accounting for 52.2%. The most common associated defect was patent ductus arteriosus (69.6%). Echocardiography was quite accurate in diagnosing patient characteristics when compared with surgical reports. 8.7% of patients had inaccurate assessment of pulmonary valve leaflet characteristics. Conclusion: Echocardiography is non-invasive, safe, has good correlation with intraoperative characteristics, and can be thoroughly applied at all times before, during, and after surgery. Improved echocardiographic methods are needed to overcome the limitations in assessing pulmonary valve characteristics in tetralogy of Fallot.

Coronary artery fistulas mimic and misdiagnosis with ruptured sinus of Valsalva: 3 cases report and the role of imaging modalities for diagnosis

Le Huu Dung — 2025-07-25

Coronary arterial fistulas (CAFs) are uncommon, although they are one of the most prevalent coronary artery anomalies and typically present with no symptoms in young patients. We report three cases of CAFs in which 2 cases were diagnosed with ruptured sinus of Valsalva aneurysm (RSVA) before surgery. Coronary computer tomography angiography (CCTA) is useful for evaluating CAFs because it requires less acquisition time and produces better temporal and spatial resolution than other imaging.