Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam

Epicardial Substrate Ablation for Brugada Syndrome with frequent ICD Shocks: Short and Mid-term Outcomes

Nguyen Xuan Tuan, Pham Nhu Hung, Hoang Van, Le Van Nam

Background: While implantable cardioverter defibrillator (ICD) remains the cornerstone therapy for high-risk Brugada syndrome patients, recurrent ventricular arrhythmias and frequent ICD shocks can significantly impair their quality of life. Epicardial substrate ablation targeting abnormal electrograms has been reported as a potential therapeutic option for these patients. This study aims to evaluate the feasibility, safety and outcomes of epicardial substrate ablation in patients with Brugada syndrome experiencing recurrent ventricular arrhythmias and frequent ICD shocks. Methods: We conducted a single-center retrospective study including patients with symptomatic type 1 Brugada syndrome who underwent ICD implantation at Hanoi Heart Hospital between 2016 and 2026. Among them, patients who experienced recurrent appropriate ICD shocks despite medical therapy and subsequently underwent epicardial catheter ablation were included. Electroanatomical mapping was performed using a three-dimensional mapping system to identify abnormal epicardial substrates. Radiofrequency ablation was delivered to eliminate these substrates. Procedural characteristics, complications, and follow-up outcomes were analyzed. Results: 11 male patients (mean age 46.18 ± 14.43 years) underwent epicardial ablation. Successful epicardial access was achieved in all cases. The mean procedure time was 172.4 ± 12.8 minutes. The anterior RVOT was the primary ablation target in all patients, with additional lateral or inferolateral substrate identified in some cases. During a median follow-up of 39 (7–78) months, ventricular arrhythmia recurrence occurred in three patients (27.3%), and repeat ablation was required in two (18.2%). 8 patients (72.7%) remained free of ICD shocks. One patient developed pericarditis requiring pericardiocentesis, and one developed ICD infection during follow-up. Conclusion: Epicardial substrate ablation appears to be a feasible and safe strategy for reducing ventricular arrhythmia burden and ICD shocks in patients with Brugada syndrome. Larger studies are needed to confirm its long-term efficacy.

Desmoid-Type Fibromatosis of the Neck with Brachial Plexus Involvement: A Rare Case Report

Vu Xuan Hiep, Phung Duy Hong Son, Nguyen Viet Anh

Introduction: Desmoid-type fibromatosis (DTF) is a rare soft tissue tumor arising from musculoaponeurotic connective tissue, characterized by locally aggressive growth and a high rate of local recurrence despite the absence of metastatic potential. Case summary: We report a case of a 19-year-old female patient presenting with a right cervical–supraclavicular mass associated with progressive upper limb numbness. Magnetic resonance imaging showed a large soft tissue mass infiltrating adjacent muscles and surrounding the bundles of the brachial plexus. Ultrasound-guided needle biopsy confirmed the diagnosis of desmoid-type fibromatosis. The patient underwent surgical dissection with maximal tumor resection combined with decompression and preservation of the brachial plexus. Postoperative histopathological results were consistent with DTF, with immunohistochemical staining for β-catenin positive. The postoperative course was favorable, with marked improvement in neurological symptoms and preservation of upper limb function. Although postoperative magnetic resonance imaging revealed residual lesions, the patient was selected for periodic follow-up instead of radiotherapy due to the risk of long-term radiation-related complications in a young patient. Conclusion: This case demonstrates that maximal tumor resection combined with preservation of neural structures may be an appropriate treatment strategy for desmoid-type fibromatosis of the cervical–supraclavicular region involving the brachial plexus.

Surgical outcomes of infective abdominal aortic aneurysm with extra-anatomic bypass and in-situ reconstruction: A single-center case series

Background: Infective (mycotic) abdominal aortic aneurysm (IAAA) is a rare but life-threatening condition with mortality rates of 20–40% even with treatment. In Southeast Asia, Salmonella spp. accounts for a disproportionate share of causative organisms compared to Western cohorts. Optimal revascularization strategy — extra-anatomic bypass (EAB) versus in-situ reconstruction (ISR) — remains debated. Methods: We conducted a retrospective review of all patients diagnosed with IAAA and treated surgically at the Department of Thoracic and Vascular Surgery, University Medical Center Ho Chi Minh City (UMC-HCMC), between January 2022 and January 2025. Patient demographics, clinical presentation, microbiological findings, antibiotic management, operative technique, and short-term outcomes were analyzed. Results: Four male patients underwent open surgical repair. All aneurysms were infrarenal; three were saccular and one was a pseudoaneurysm. Salmonella spp. (ESBL-negative, AmpC-negative) was identified in one patient by positive blood culture. EAB was performed in three patients using woven polyester (Dacron) grafts. ISR with a rifampicin-soaked Dacron bifurcated prosthesis was performed in one patient with extensive para-aortic abscess and concomitant duodenal perforation. All patients received targeted antibiotic therapy for 4–6 weeks postoperatively; the confirmed Salmonella case received an additional 3-month course of oral ciprofloxacin. Technical success was achieved in all four cases. There was no 30-day mortality. Conclusions: Open surgical repair of IAAA is feasible and effective in a tertiary centre. EAB remains the preferred strategy when anatomy allows complete exclusion of the infected field. ISR may be necessary in anatomically complex cases with extensive retroperitoneal involvement. Prolonged antibiotic therapy tailored to microbiological findings is essential for both early outcomes and long-term graft preservation. A multidisciplinary approach is essential for cases with multi-organ extension.

Feasibility and outcomes of an endovascular aortic program in a provincial hospital: a 5-year single-center experience

Background Endovascular aortic repair has become the standard treatment for many aortic diseases; however, its implementation remains limited in provincial hospitals in developing countries. This study aimed to evaluate the feasibility, safety, and clinical outcomes of an endovascular aortic program in a provincial hospital setting. Methods This was a single-center retrospective cohort study including 52 consecutive patients undergoing endovascular aortic interventions between April 2021 and April 2026 at Dong Nai General Hospital, Vietnam. Procedures included EVAR, TEVAR, and hybrid interventions with debranching techniques. Primary endpoints were technical success and early outcomes (≤30 days). Secondary endpoints included midterm survival and freedom from reintervention, analyzed using Kaplan–Meier methods. Results The mean age was 68.7 ± 9.4 years, with 75% male patients. EVAR accounted for 59.6% and TEVAR for 40.4% of procedures, with 26.9% requiring hybrid approaches. Technical success was achieved in all cases (100%). Early mortality was 3.8%, and major morbidity occurred in 5.8%. During follow-up up to 5 years, two late deaths were recorded, both unrelated to aortic causes. No reinterventions were required, with 100% freedom from reintervention and no significant endoleaks or aneurysm progression observed. Conclusions An endovascular aortic program can be safely and effectively implemented in a provincial hospital with appropriate patient selection, structured training, and multidisciplinary collaboration. Decentralization of aortic care may improve access to treatment while maintaining favorable clinical outcomes.

Outcomes of endovascular treatment for acute aortic syndrome at Thong Nhat Hospital

Nguyen Duy Tan, Huynh Ngoc Hanh, Lam Thao Cuong

Introduction: Acute aortic syndrome (AAS) is a life-threatening emergency encompassing aortic dissection, intramural hematoma (IMH), penetrating aortic ulcer (PAU), and aortic rupture/pseudoaneurysm. Mortality reaches 50–90% without timely intervention. Endovascular stent-grafting has become the preferred approach for descending aortic lesions. Objective: To evaluate clinical characteristics, lesion morphology, and early outcomes of endovascular treatment for AAS at Thong Nhat Hospital. Methods: A retrospective descriptive study of 22 patients diagnosed with AAS and treated by endovascular stent-grafting from June 2020 to January 2024. Lesion classification followed the Svensson system and the 2014 ESC Guidelines. Categorical variables were analyzed using Fisher’s exact test; continuous variables using the independent samples t-test. Results: 22 patients (male 72.7%; mean age 58.5 ± 14.2 years). Lesion types: aortic dissection 45.5%, aortic rupture/pseudoaneurysm 27.3%, PAU 22.7%, IMH 4.5%. Most common proximal landing zones: zone 0 (22.7%) and zone 2 (36.4%). Supra-aortic vessel transposition was required in 68.2% of cases. Technical success rate was 77.3%. Complications (each 4.5%): endoleak, retrograde type A dissection, aortic/iliac rupture, cerebral embolism, and acute limb ischemia. In-hospital mortality was 9.1% (2/22). Conclusion: Endovascular stent-grafting is a feasible, safe and effective treatment for AAS with acceptable in-hospital mortality. Larger cohorts and longer follow-up are needed to evaluate mid- and long-term outcomes.

"Through-the-strut" re-entry technique: a successful endovascular salvage of iatrogenic subintimal stent deployment in the common iliac artery

Vo Tuan Anh, Nguyen Cong Tien, Nguyen Thoi Hai Nguyen

Introduction: Endovascular-first strategies for aortoiliac occlusive disease (AIOD) are standard, yet they carry risks of iatrogenic complications. Subintimal stent deployment is a rare but limb-threatening event that traditionally requires emergency open surgery. This report describes a successful endovascular bailout using a novel through-the-strut re-entry technique. Case presentation: A 58-year-old male with diabetes and a 40 pack-year smoking history presented with rest pain and cyanosis of the right first toe (Rutherford 4). Imaging confirmed severe right common iliac artery (CIA) stenosis. During intervention, a 0.035” hydrophilic wire inadvertently created a subintimal dissection. A 7 – 57 mm balloon-expandable stent (Besmooth) was deployed within the false lumen, causing acute limb ischemia. The complication was managed by navigating a 5F JR catheter through the misplaced stent's struts to re-access the true lumen. After sequential balloon dilatation through the struts (4F to 7F), an 8 – 100 mm self-expanding Lifestent was deployed to re-line the artery, crushing the initial stent against the wall. Immediate blood flow was restored. The ankle-brachial index improved from 0.4 pre-procedure to 1.1 after intervention. At 6-month follow-up, the patient remained asymptomatic with a patent "stent-in-stent" complex on CTA. Conclusion: Iatrogenic subintimal stent deployment can be successfully salvaged through the "through-the-strut" technique. This approach avoids the high morbidity of emergency open bypass in high-risk patients and provide an effective endovascular bailout strategy to restore true lumen perfusion and avoid emergency surgical conversion in selected patients..

Blunt chest trauma at a regional Tay Nguyen hospital: frequent pleuropulmonary injuries and the significance of follow-up after tube thoracostomy

Nguyen Do Nhan, Duong Minh Tri

Background: Chest trauma is a common surgical emergency with diverse presentations and a high mortality rate. The Tay Nguyen region has distinctive characteristics in terms of terrain, transportation, and delayed access to healthcare, which may affect diagnosis, management, and treatment outcomes. However, data on this condition in the region remain limited. Objective: To investigate the clinical and paraclinical characteristics of chest trauma and evaluate treatment outcomes at Tay Nguyen Regional General Hospital. Materials and methods: A retrospective, descriptive analytical study was conducted on 55 patients with thoracic trauma diagnosed and treated at Tay Nguyen Regional General Hospital between January 2024 and June 2025. Results and discussion: males were 81.8%, the mean age was 52.78. Road traffic accidents were the leading cause (85.4%). The chest pain symptom was 100% and dyspnea was 56.36%. Rib fracture was the most common injury (94.5%). Pleuropulmonary injuries were identified in 74.5%. Tube thoracostomy was the most common initial treatment modality (63.6%), conservative management was 36.4%. The treatment success rate was 95.0% in the conservative group and 74.3% in the tube thoracostomy group (p = 0.075). Complications occurred in 18.2%, and no in-hospital mortality was recorded. The mean hospital stay was 9.8 days; patients with complications had a significantly longer hospital stay than those without complications (15.2 ± 7.3 vs. 8.6 ± 4.1 days; p = 0.006). Conclusion: Chest trauma at Tay Nguyen Regional General Hospital was more common in working-age males, with road traffic accidents being the predominant cause. Rib fractures and pleuropulmonary injuries were the most prominent findings. Tube thoracostomy was the main treatment modality. Although no in-hospital mortality was observed, complications still occurred at a considerable rate and were associated with prolonged hospitalization, highlighting the need for close monitoring after initial treatment, especially in patients with pleural space injuries.

Endovascular drug-eluting stent placement for superficial femoral artery occlusive disease: midterm outcomes at a single centre

Le Phi Long, Nguyen Minh Tan, Lam Thao Cuong

Background: The Eluvia drug-eluting stent (DES; Boston Scientific) — a paclitaxel-eluting nitinol stent with a sustained-release fluoropolymer coating — has demonstrated superior restenosis inhibition compared with bare-metal stents for superficial femoral artery (SFA) disease. Systematic data on midterm outcomes in the Vietnamese clinical setting remain limited. Objective: To describe the clinical characteristics, lesion morphology, procedural parameters, and midterm outcomes (12- and 24-month Kaplan-Meier estimates) of Eluvia DES implantation for SFA occlusive disease at University Medical Center Ho Chi Minh City (UMC HCMC). Patients and methods: Retrospective single-arm descriptive study analysing 71 consecutive patients who underwent Eluvia stent implantation between January 2021 and January 2024. Patency and survival rates were estimated using the Kaplan-Meier method. Results: Mean age was 72.1 ± 9.4 years; 73.2% were male; mean BMI was 21.3 ± 2.9 kg/m². Comorbidities included diabetes mellitus (63.4%), hypertension (73.2%), and smoking (97.2%); 39.4% had chronic limb-threatening ischaemia (CLTI). Chronic total occlusion (CTO) accounted for 47.9% of lesions; mean DSA lesion length was 177 ± 98 mm; mean total stent length was 202.4 ± 46.7 mm (2.1 ± 0.8 stents/patient). Rutherford IV predominated (54.9%). Technical success was 100% by SVS criteria. Kaplan-Meier estimates at 12 and 24 months were: primary patency 90.1% and 73.2%; overall survival 94.3% and 84.5%; and freedom from clinically driven target lesion revascularisation (CD-TLR) 91.5% and 78.8%, respectively. ABI improved from 0.43 ± 0.18 to 0.83 ± 0.14 (p < 0.001). Conclusion: Eluvia DES implantation for SFA occlusive disease is feasible with encouraging initial results at a Vietnamese tertiary cardiovascular centre. The single-arm retrospective design precludes comparative conclusions; prospective controlled studies are warranted.

Case report: leimyosarcoma of the pulmonary valve

Van Hung Dung

Myxomas in the heart are the most common type of benign primary tumor, accounting for over 95% of cases. Malignant tumors such as rhabdomyosarcoma, angiosarcoma, fibrosarcoma or leiomyosarcoma are less common and are usually found in the left heart rather than the right. According to the literature, intimal sarcoma is the most common type, accounting for about 42%. Intimal sarcoma includes all the types mentioned above.We report a very rare case: leiomyosarcoma of the pulmonary artery valve. A 57-year-old male patient was admitted due to fatigue. Ultrasound and MSCT showed images suggestive of a myxoma in the pulmonary artery trunk and left pulmonary artery. Abdominal MSCT and coronary angiography yielded normal results. Surgery to remove the tumor en bloc followed by pulmonary valve replacement by tissue valve. The postoperative course was uneventful, without complications, and he was discharged after 7 days. Immuno-histopathology results shoewd a poorly differentiated leiomyosarcoma. Conclusion: Accurate and early diagnosis of malignant pulmonary artery tumors remains a challenge. MSCT is a useful imaging tool to help determine the cause.

Clinical characteristics, prompt diagnosis, and in-hospital treatment outcomes of acute renal artery occlusion at Cardiovascular Center – E Hospital

Objectives: To describe clinical characteristics and evaluate treatment outcomes of patients with acute renal artery occlusion at E Hospital. Methods: A cross-sectional study on 36 patients diagnosed from Jan 2023 to Oct 2025. Results: Mean age 58.47 ± 13.24; male/female ratio 16/20. Flank pain presented in 100%, with delayed admission (mean 4.97 days). Major causes: cardiac embolism (44.4%) and idiopathic (41.8% - with 27.8% cancer-related). Treatment: 88.9% conservative (anticoagulation), 11.1% percutaneous revascularization (early admission <24h). Outcomes showed significant renal function improvement at discharge; no mortality occurred. Conclusion: Acute renal artery occlusion is often missed due to non-specific symptoms. Early MSCT diagnosis and individualized strategies (anticoagulation vs. intervention) are crucial for renal salvage.

Tetralogy of Fallot Associated With a Restrictive Ventricular Septal Defect in an Infant: A Case Report

Le Ngoc Minh, Nguyen Ba Phong, Luong Tuan Bao, Do Anh Tien

Background : Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart defects. In most patients the ventricular septal defect (VSD) is large and non-restrictive, allowing equalization of ventricular pressures. TOF associated with a restrictive VSD is a rare variant in which the interventricular pressure gradient elevates right ventricular pressure, altering the hemodynamic profile and complicating both diagnosis and surgical management. Case presentation : A 3-month-old female infant (4.8 kg) presented with progressive cyanosis and oxygen saturation of 70–72% in room air. Echocardiography and cardiac computed tomography demonstrated TOF with a restrictive perimembranous VSD (approximately 3 mm; interventricular gradient 52 mmHg) and severe right ventricular outflow tract (RVOT) obstruction (peak gradient 77 mmHg). Complete repair was performed through a minimally invasive lower partial sternotomy. The early postoperative course was complicated by right ventricular dysfunction with myocardial edema and fluid overload, requiring delayed sternal closure, multiple inotropes, and peritoneal dialysis. The patient recovered gradually; at 3-month follow-up she was thriving, with good biventricular function, no residual shunt, and only mild residual RVOT obstruction. Conclusion : TOF with a restrictive VSD is a rare variant whose distinct hemodynamics predispose to postoperative right ventricular dysfunction. Accurate preoperative diagnosis, an individualized surgical strategy, and anticipatory management of right heart failure are essential for a favorable outcome, even in young infants.

Evaluation of the treatment outcomes of preoperative concurrent chemoradiotherapy for patients with stage ii, iii esophageal cancer at 175 Military Hospital

Objectives: To describe some clinical and paraclinical characteristics and evaluate the treatment outcomes of preoperative concurrent chemoradiotherapy for patients with stage II, III esophageal cancer (EC) at 175 Military Hospital. Subjects and methods: A descriptive retrospective combined prospective study on 36 patients with stage II, III esophageal cancer who received preoperative concurrent chemoradiotherapy with the weekly Paclitaxel/Carboplatin regimen (Paclitaxel 50 mg/m², Carboplatin AUC 2) combined with radiotherapy of 41.4 Gy/23 Fx, followed by surgery 4–8 weeks later, from January 2021 to April 2026. Results: The mean age was 60.67 ± 7.79 years; 97.2% were male; 97.2% of patients had a history of smoking and/or alcohol use. Dysphagia was observed in 100% of patients, mostly grade 2 (58.3%); all patients reported weight loss. Pathology was squamous cell carcinoma in 100% of cases; the mean tumor length was 5.52 ± 1.18 cm; 88.9% were T3 and 11.1% T4; stage III accounted for 83.3%. After chemoradiotherapy, the symptomatic response rate was 91.7%, and the response rate according to RECIST 1.1 was 88.9% (complete response 13.9%, partial response 75.0%). 63.9% of patients underwent surgery, with an R0 resection rate of 95.7%; the pathologic complete response (pCR) rate was 39.1%. The median disease-free survival (DFS) was 24 months, and the median overall survival (OS) was 47 months. Overall survival (OS) at 12, 24, and 36 months was 96.8%, 93.2%, and 69.9%, respectively; disease-free survival (DFS) at 12, 24, and 36 months was 79.2%, 48.4%, and 36.3%, respectively. The surgical group had a median OS of 51 months and median DFS of 38 months, markedly longer than the non-surgical group (OS 31 months, DFS 17 months). Toxicity was mostly grade 1–2: esophagitis 94.4%, dermatitis 86.1%, pneumonitis 69.4%, leukopenia 50.0% (only 2.8% grade 3); no grade 4 toxicity was observed. Conclusion: Preoperative concurrent chemoradiotherapy with the weekly Paclitaxel/Carboplatin regimen combined with radiotherapy of 41.4 Gy/23 Fx is an effective and well-tolerated treatment for patients with stage II, III esophageal cancer at 175 Military Hospital.

Transoral Endoscopic Thyroidectomy: Early Outcomes at Military Hospital 175

Nong Huu Tho, Tran Hong Quang, Nguyen Viet Cuong, Dang Le Hong Ngan

Background: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers genuinely scarless access to the thyroid gland, yet institutional data from Vietnam remain sparse. We report the early outcomes at Military Hospital 175 following introduction of the technique in January 2024. Methods: A prospective descriptive case series of 65 consecutive patients undergoing TOETVA at Military Hospital 175 between November 2025 and May 2026. Primary endpoints were operative time, estimated blood loss, length of hospital stay, early complication rates, postoperative pain assessed by visual analogue scale (VAS) on day 1, and cosmetic satisfaction (VAS at 1 month post-operatively). Results: The cohort was predominantly female (86.2%; mean age 31 ± 9.7 years). Mean operative time was 90 min (range 70–120), mean blood loss 6.67 ± 2.3 mL, and mean hospital stay 7.1 ± 1.8 days. Transient complications included mental nerve paraesthesia (12.3%), temporary hoarseness (7.7%), delayed vocal recovery (3.1%), and cervical seroma (4.6%). One patient developed transient hypocalcaemia (1.5%). Two cases (3.1%) required conversion to open surgery, both due to uncontrolled intraoperative haemorrhage. No permanent complications were observed. Cosmetic satisfaction VAS at 1 month was 7.4 ± 0.9, with 55.4% of patients reporting very high satisfaction (VAS ≥ 8). Conclusion: TOETVA is safe and feasible during the early institutional implementation phase, with a complication profile comparable to published international series and high patient-reported cosmetic satisfaction. Expansion within the Vietnamese military and civilian healthcare system is warranted for appropriately selected patients.

Efficacy of adjuvant chemoradiotherapy in patients with macroscopic residual or recurrent non-small cell lung cancer after surgery

Objective: To evaluate the clinicopathological characteristics of patients with non-small cell lung cancer (NSCLC) presenting with macroscopic residual nodal disease or post-operative recurrence, and to assess the efficacy of adjuvant chemoradiotherapy in these patient groups. Patients and Methods: Patients diagnosed with non-small cell lung cancer who underwent surgical resection and were subsequently assessed for residual disease or post-operative recurrence. Results: A total of 37 patients had post-operative recurrence and 31 patients had residual tumor. Lymph node stations 4R and 7 accounted for the highest rates of nodal metastasis (36% and 51.4%, respectively). Median overall survival was 18.6 months in the recurrence group and 25.4 months in the residual disease group.

Three-Dimensional Electroanatomic Mapping-Guided Complete Zero-Fluoroscopy Ablation of Premature Ventricular Complexes: Feasibility and Patient Selection Characteristics

Background: Complete zero-fluoroscopy ablation of premature ventricular complexes (PVCs) guided by three-dimensional electroanatomic mapping may eliminate radiation exposure. However, its feasibility depends on appropriate patient selection, particularly in settings where intracardiac echocardiography is not routinely available. Objective: To evaluate the feasibility of complete zero-fluoroscopy PVC ablation and to identify electrocardiographic characteristics associated with successful completion of the procedure without fluoroscopy. Methods: This descriptive observational study included patients undergoing catheter ablation for PVCs at the Cardiovascular Center, E Hospital, from January 2025 to May 2026. Clinical characteristics, 12-lead electrocardiographic findings, Holter data, anatomical sites of origin, and procedural outcomes were analyzed according to whether the procedure was completed entirely without fluoroscopy. Results: A total of 60 patients were included. Forty patients were initially selected for a complete zero-fluoroscopy strategy, of whom 37 completed the procedure without fluoroscopic guidance, yielding a feasibility rate of 92.5%. Three patients crossed over to fluoroscopic support; the final sites of origin were the right coronary cusp in one patient and suspected intramural origins in two patients. Compared with the fluoroscopy-used group, the complete zero-fluoroscopy group had a lower R/RS ratio in lead V2 during PVCs (0.13 ± 0.10 vs. 0.42 ± 0.34, p < 0.001), a later PVC precordial transition index (2.94 ± 1.10 vs. 2.00 ± 0.60, p < 0.001), and a lower V2 transition ratio (0.41 ± 0.31 vs. 1.94 ± 2.90, p < 0.001). In the complete zero-fluoroscopy group, acute procedural success was achieved in 97.3% of patients; mean procedural time was 60.1 ± 29.2 minutes and mean ablation time was 346.5 ± 196.4 seconds. No major complications occurred. Conclusion: Three-dimensional electroanatomic mapping-guided complete zero-fluoroscopy ablation of PVCs is highly feasible in appropriately selected patients. Electrocardiographic features suggesting late precordial transition may support patient selection for this strategy.

Characteristics of chylothorax following pediatric congenital heart surgery at Cho Ray Hospital

Le Thanh Khanh Van, Nguyen Tran Khanh Linh, Doan Van Phung

Objective: To evaluate the characteristics of postoperative chylothorax in pediatric patients undergoing cardiac surgery at the Pediatric Cardiac Surgical Department, Cho Ray Hospital, from March 2017 to May 2026. Methods: This retrospective descriptive cross-sectional study included all pediatric patients diagnosed with postoperative chylothorax at the Pediatric Cardiac Surgical Department, Cho Ray Hospital, between March 2017 and May 2026. Clinical data and treatment outcomes were collected and analyzed using statistical methods. Results: Over the nearly nine-year study period, 21 cases of chylothorax following congenital heart surgery in children were identified. Most patients had complex congenital heart disease, particularly single-ventricle physiology. The most common surgical procedures were the Fontan operation (47.6%) and bidirectional Glenn shunt (23.8%). Chylothorax predominantly developed after postoperative day 7 and was more frequently observed in the right pleural cavity (61.9%). Most patients had a pleural drainage volume of less than 40 mL/kg/day. Management primarily consisted of pleural drainage combined with conservative medical therapy, with a mean drainage duration of 6.6 ± 2.3 days. Conclusions: Postoperative chylothorax in pediatric congenital heart surgery patients occurred predominantly in those with complex congenital heart disease, particularly single-ventricle physiology, following Glenn and Fontan procedures. This complication typically presented late in the postoperative period, was mainly right-sided, and was generally associated with mild to moderate drainage volumes. Conservative management combined with pleural drainage yielded favorable outcomes in most cases.

Patient satisfaction after sandwiched double-bar repair for pectus excavatum

Dao Thuy Phuong, Tran Minh Bao Luan, Nguyen Hoai Nam

Background: Pectus excavatum may affect body appearance, psychosocial well-being, and quality of life. Data on patient satisfaction after double-bar repair in Vietnam remain limited. Objective: To evaluate satisfaction with quality of life after sandwiched double-bar repair for pectus excavatum and identify associated factors. Methods: This analytical cross-sectional study combined retrospective medical record review with postoperative patient interviews. A total of 111 patients with congenital pectus excavatum who underwent sandwiched double-bar repair at the University Medical Center Ho Chi Minh City from November 2022 to November 2024 were included. Satisfaction with quality of life was assessed using the Single Step Questionnaire (SSQ) 6 months after surgery. Fisher’s exact test was used to analyze factors associated with satisfaction. Results: The overall satisfaction score was 3.77 ± 0.24, and the overall satisfaction rate was 87.4% (97/111). The highest satisfaction rate was observed in the social domain (86.5%), followed by psychological well-being (80.2%), cosmetic appearance (73.9%), physical function (66.7%), and body perception (60.4%). Early and late postoperative complications were significantly associated with satisfaction after surgery (p<0.001 and p=0.012, respectively). Conclusion: sandwiched double-bar repair for pectus excavatum achieved a high level of satisfaction with quality of life. Prevention of complications, pain control, and management of discomfort related to the implanted bars should be emphasized to improve postoperative patient experience.

Technical Characteristics and Outcomes of Totally Endoscopic Mitral Valve Repair for Isolated Posterior Leaflet Lesions: A Single-Center Study

Objective This study aimed to describe repair techniques and evaluate early and mid-term outcomes of totally endoscopic mitral valve repair for primary mitral regurgitation caused by isolated posterior leaflet lesions. Methods A retrospective descriptive study was conducted on 183 consecutive patients with primary mitral regurgitation caused by isolated posterior leaflet lesions who underwent totally endoscopic mitral valve repair at the Cardiovascular Center, E Hospital, from January 2021 to June 2025. Patients with rheumatic mitral disease, anterior leaflet involvement, bileaflet lesions, or intraoperative conversion to mitral valve replacement were excluded. Surgical techniques were selected according to lesion morphology and included triangular resection, quadrangular resection, folding repair, commissural repair, vegetation resection, annular decalcification, artificial chordal implantation, and annuloplasty when indicated. Early postoperative outcomes and mid-term follow-up results were analyzed. Results The mean age was 55.7 ± 12.6 years, and 67.2% of patients were male. Severe mitral regurgitation was present in 97.8% of patients before surgery. Carpentier type II dysfunction predominated, accounting for 96.7% of cases. The most frequent lesion was chordal rupture, observed in 85.8%, and P2 was the most commonly involved segment. Triangular resection, quadrangular resection, and folding repair were the most frequently used repair techniques. The mean aortic cross-clamp and cardiopulmonary bypass times were 72 ± 24 minutes and 120 ± 30 minutes, respectively. Early mortality occurred in one patient, representing 0.5%. Predischarge echocardiography showed no moderate or severe residual mitral regurgitation. At mid-term follow-up, available in 169 patients, 97.0% remained free from moderate-or-greater recurrent mitral regurgitation, and only one patient required reoperation. Conclusion Totally endoscopic mitral valve repair for isolated posterior leaflet lesions is feasible, safe, and effective. In appropriately selected patients, this approach provides excellent early repair quality, low perioperative morbidity, and favorable mid-term durability.

Left ventricle reverse remodeling after barlow mitral valve repair with leaflet preservation versus leaflet resection

Luong Cong Hieu, Nguyen Hoang Dinh, Pham Tho Tuan Anh, Tran Minh Bao Luan

Background: Left ventricular (LV) remodeling is a characteristic consequence of chronic volume overload in Barlow’s disease. While mitral valve repair (MVR) is the gold standard treatment, the impact of specific surgical techniques—specifically leaflet preservation ("Respect") versus leaflet resection ("Resect")—on the subsequent process of LV reverse remodeling remains a subject of clinical debate. Methods: We conducted a study of 68 patients with Barlow’s disease who successfully underwent minimally invasive MVR at University Medical Center between 2020 and 2025. Patients were evaluated using preoperative and postoperative echocardiography at discharge and 1-year follow-up to track LV morphological evolution and functional recovery. Results: A significant reverse remodeling process was observed across the cohort, with LV end-diastolic diameter (LVEDD) decreasing from 58.1 ± 5.0 mm to 47.8 ± 6.2 mm at one year (p < 0.001). An initial "LVEF paradox" was noted, where mean LVEF dropped from 62.3% to 53.4% at discharge before rebounding to 57.6% at 12 months. Subgroup analysis revealed that the "Respect" technique (n=37) achieved significantly higher mean LVEF at 1-year (59.1 ± 5.4%) compared to the "Resect" technique (55.9 ± 6.2%, p = 0.018). Furthermore, 82.6% of "top performers" (LVEF > 60%) were from the Respect group. Optimized annular downsizing (7–11 mm) was also strongly correlated with superior systolic recovery. Conclusions: Surgical repair for Barlow’s disease facilitates robust LV reverse remodeling. However, a leaflet-preservation strategy ("Respect") combined with optimized annular downsizing provides superior 1-year functional outcomes compared to leaflet resection, supporting a "Respect-first" approach to maximize hemodynamic benefits.

Late Complications and Functional Outcomes After Nonoperative Management Versus Surgical Stabilization of Rib Fractures in Patients with Blunt Chest Trauma: A 12-Month Multicenter Study

Background: Late consequences after multiple rib fractures remain clinically important, especially in patients managed nonoperatively. This study aimed to compare 12-month late complications and functional outcomes between nonoperative management and surgical stabilization of rib fractures (SSRF) in patients with blunt chest trauma. Methods: This multicenter prospective cohort included 192 eligible patients with blunt chest trauma and rib fractures treated at three Vietnamese trauma centers, comprising 64 patients treated with SSRF and 128 managed nonoperatively. Twelve-month outcomes were assessed in an extended follow-up conducted after completion of the primary study. This complete-case analysis included 155 of the 192 patients: all 64 patients (100%) in the SSRF group and 91 of 128 patients (71.1%) in the nonoperative group; all 37 losses to follow-up occurred in the nonoperative group. Treatment allocation was nonrandomized, and comparisons were unadjusted for baseline differences between groups. The primary outcome was chronic chest wall pain at 12 months. Secondary outcomes included exertional dyspnea, chest wall deformity, clinical symptoms suggestive of rib malunion/nonunion, pulmonary function, EQ-5D-5L, and return to work. Results: In this unadjusted complete-case comparison, patients who underwent SSRF had lower rates of chronic chest wall pain (10.9% vs. 34.1%, p=0.001), exertional dyspnea (12.5% vs. 31.9%, p=0.006), chest wall deformity (3.1% vs. 16.5%, p=0.012), and clinical symptoms suggestive of rib malunion/nonunion (4.7% vs. 18.7%, p=0.015) than patients managed nonoperatively. Patients who underwent SSRF also had higher 12-month FVC (90.8±9.4% vs. 82.1±12.6% predicted, p<0.001), FEV1 (88.7±10.1% vs. 80.4±13.2% predicted, p<0.001), and EQ-5D-5L index (0.93±0.08 vs. 0.84±0.13, p<0.001). The two groups differed significantly at baseline in injury severity score, admission pain score, and frequency of flail chest and chest wall deformity. Conclusion: In this multicenter prospective cohort, patients who underwent SSRF had more favorable observed 12-month pain, pulmonary-function, and quality-of-life outcomes than complete-case participants managed nonoperatively. However, these comparisons were unadjusted and were affected by substantial baseline imbalance and differential loss to follow-up. The findings should therefore be considered exploratory and should not be interpreted as establishing a causal treatment effect. Further studies using adjusted analyses, standardized imaging follow-up, and health-economic evaluation are warranted.