Background: Iatrogenic diversion of the inferior vena cava (IVC) to the left atrium (LA) can occur in patients who have undergone atrial septal defect (ASD) closure. This can result in hypoxemia and life-threatening complications, such as stroke, due to paradoxical embolism. Currently, this complication is rare owing to transesophageal echocardiography (TEE) performed during the surgery in the operating room.Case: We report a case of a patient with a longstanding, unrecognized chronic dyspnea after ASD closure who subsequently experienced a stroke. Following the diagnosis of iatrogenic diversion of the IVC into the LA, surgical correction was undertaken, and the dyspnea was resolved completely.Conclusions: Some patients who undergo ASD closure during childhood can reach adulthood with undiagnosed or misdiagnosed dyspnea.
Background: Postoperative atrial fibrillation (PoAF) remains the most common complication after coronary artery bypass grafting (CABG). The visceral adiposity index (VAI) is a composite marker of visceral adipose dysfunction and metabolic risk. This study aimed to evaluate the association between preoperative VAI and PoAF in patients undergoing isolated on-pump CABG.Methods: This retrospective, single-center cohort study included 400 consecutive patients who underwent isolated on-pump CABG between January 2019 and December 2023. VAI was calculated using sex-specific formulas that incorporated body mass index, waist circumference, triglyceride levels, and high-density lipoprotein cholesterol levels. Patients were categorized according to the median VAI value (2.87) for descriptive analyses. The primary outcome was new-onset PoAF during the index hospitalization. Multivariable logistic regression analysis was performed to identify independent predictors of PoAF. Receiver operating characteristic (ROC) analysis was used to evaluate the discriminative performance of VAI.Results: PoAF occurred in 61 patients (15.3%). Patients with VAI >= 2.87 had a significantly higher incidence of PoAF than those with VAI <2.87 (21.4% vs. 9.0%; p < 0.001). In multivariable logistic regression analysis adjusted for age, sex, left ventricular ejection fraction, and cardiopulmonary bypass duration, VAI remained independently associated with PoAF (odds ratio (OR) 1.34 per unit increase, 95% confidence interval (CI) 1.09-1.63; p = 0.005). ROC analysis demonstrated good discriminative ability of VAI for predicting PoAF (area under the curve [AUC] 0.85, 95% CI 0.79-0.90). Exploratory ROC analysis identified a VAI threshold of 3.5, corresponding to a sensitivity of 91% and a specificity of 68%.Conclusions: Higher preoperative VAI was independently associated with PoAF in patients undergoing isolated on-pump CABG. As an easily obtainable marker of visceral adiposity and metabolic dysfunction, VAI may provide complementary information for preoperative risk assessment. However, the ROC findings should be considered exploratory, and external validation is required before routine clinical application.
Background: Right ventricle-to-pulmonary artery (RV-PA) valved conduits are widely used for right ventricular outflow tract (RVOT) reconstruction in complex congenital heart disease. However, in developing countries, this technique is still limited to a few major centers, and evidence on long-term outcomes remains scarce. This study aimed to report early- and mid-term outcomes of RVOT reconstruction using biological valved conduits in pediatric patients at a Vietnamese tertiary center.Methods: We retrospectively reviewed all pediatric patients with complex congenital heart disease who underwent RVOT reconstruction with a biological valved conduit at our institution between March 2017 and August 2022. Patients were described overall and by clinical strata (first conduit for RVOT obstruction vs second conduit and pulmonary valve stenosis (PVS)). Outcomes included perioperative characteristics, in-hospital complications, mortality, echocardiographic assessment of conduit performance, and conduit-related reintervention or replacement.Results: A total of 34 children underwent RVOT reconstruction with 38 conduit procedures. The median age was 4.0 years (interquartile range 1.0-10.3), and 55.9% were male. Preoperative malnutrition was present in 38.2%, and prior cardiac surgeryor intervention in 67.6%. The RVOT obstruction subgroup had marked baseline hypoxemia, with a mean peripheral capillary oxygen saturation of 73.8%. Postoperative complications were frequent, particularly pneumonia (42.1%) and low cardiac output syndrome/heart failure (28.9%). Early mortality occurred in two patients (5.9%), and late mortality in one patient (2.9%). No conduit-related interventions were required during the index hospitalization. At discharge, the median systolic conduit gradient was 20 mmHg and increased during follow-up (mean 30.3 mmHg). At follow-up, mild and moderate stenosis were observed in seven (18.4%) and two (5.3%) cases, respectively. During follow-up, four patients underwent surgical conduit replacement at a median of 60 months, with severe valve calcification documented intraoperatively.Conclusions: In this single-center Vietnamese series, biological valved conduits enabled RVOT reconstruction with acceptable early outcomes despite substantial preoperative risk burden and frequent postoperative respiratory and cardiac morbidity. Mid-term follow-up demonstrated progressive conduit obstruction in a subset of patients and clinically relevant conduit replacement at approximately 5 years, consistent with structural valve degeneration.
Background: A large proportion of patients with ST-elevation myocardial infarction (STEMI) have unfavorable lifestyle habits such as smoking, insufficient physical activity, and an unhealthy diet. This situation complicates the management of cardiovascular risk factors and adversely affects clinical outcomes. The aim of this study was to evaluate the level of adherence to lifestyle modifications and medical treatment recommendations in patients after a STEMI. Methods: This is a prospective study involving 97 patients with a diagnosis of STEMI who underwent primary percutaneous coronary intervention (PCI) from October 10, 2024 to September 8, 2025. To compare pre- and post-intervention (baseline and 6-month follow-up) categorical variables such as smoking status, physical activity, dietary habits, medication adherence, and psychosocial indicators were recorded. To compare baseline and 6-month follow-up data, categorical parameters were analyzed using the standard chi-square test (or Fisher's exact test, if applicable). Results: During the 6-month follow-up period, 3 patients were excluded due to mortality (n = 2) and/or loss to follow-up (n = 1); thus, the final analysis for both baseline and 6-month follow-up assessments was conducted on 94 patients. Physiologically, body weight decreased significantly during the follow-up period. A substantial increase in regular physical activity was detected, from 18.1% at baseline to 46.8% after 6-month (p < 0.001). Medication adherence demonstrated a dramatic enhancement, with an increase from 55 (58.5%) at baseline to 93 (98.9%) 6-month later (p < 0.001). However, a significant decline in maintaining an active social life from 86.2% at baseline to 53.2% at follow-up. Conclusions: Lifestyle modifications and adherence to medication recommendations after PCI are important in the follow-up of STEMI patients. There was a significant improvement in medication adherence and regular physical activity from baseline to follow-up in STEMI patients after PCI; however, their social life activity declined. The decline in social life suggests a need for psychosocial support programs post-PCI.
Background: This study aimed to determine the impact of radial artery (RA) hyperperfusion on the first-attempt success rate of arterial catheterization and the accuracy of arterial blood gas analysis in patients with acute heart failure (AHF). Methods: From March 2024 to January 2026, 356 patients with AHF admitted to the Emergency Department of our hospital were enrolled and randomly assigned to either a non-hyperperfusion group or a hyperperfusion group (178 patients per group). Randomization was performed using a random number table. The non-hyperperfusion group received conventional blind radial artery catheterization, whereas the hyperperfusion group underwent catheterization under a hyperperfusion intervention. In the hyperperfusion group, blood gas analysis samples obtained via catheter were collected once in each of the conventional and hyperperfusion conditions. The first-time success rate of RA catheterization, catheterization time, pain score, and heart rate fluctuation were compared between the two groups. In addition, we explored the impact of hyperperfusion blood collection on the precision of blood gas analysis outcomes. Results: The first-attempt success rate of RA catheter insertion, catheterization time, pain score, and heart rate changes in the hyperperfusion group were better than those observed in the non-hyperperfusion group, with the differences being statistically significant (p< 0.05). There was no significant difference in lactic acid, pH, PaCO2, PaO2, Na+, K+, and SaO(2)in the blood gas analysis under the hyperperfusion state compared with that in the conventional state (p> 0.05). Conclusions: The hyperperfusion method improved the first-attempt success rate of RA catheterization in patients with AHF, shortened catheterization time, reduced patient pain, and had no significant effect on the accuracy of RA blood gas analysis. Clinical Trial Registration: ChiCTR2500113153,https://www.chictr.org.cn/showproj.html?proj=297512.
