Vien Tim Institut du Coeur: Success of a Congenital Heart Disease Center in a Developing Country.

OBJECTIVE: The goal of the Vien Tim Institute du Coeur is to provide high quality cardiac surgical care to the Vietnamese population with 25% of care allocated to the indigent. This article discusses the history; functional and financial implementation of creating a long-term fully sustainable adult and pediatric cardiac surgery center in Southeast Asia in a developing country. METHODS: The Institut du Coeur in Ho Chi Minh City, Vietnam is a fully functional and financially solvent cardiac surgery center that was formed 28 years ago. It was borne from the Alain Carpentier Foundation which oversees its activity and the Centre Médical International which is an outpatient clinic in Ho Chi Minh City and continues to financially support and oversee the development and future of the Institute. This article details many of the key components to the development of this sustainable program and its evolution. RESULTS: Since 1996, over 25,000 patients with complicated adult and congenital cardiac disease have been treated at the infirmary with support from the Alain Carpentier Foundation since it was established in 1992. The hospital has also performed surgery and treatment to poor patients across Vietnam with over 6,700 impoverished patients having had free operations with an estimated cost of VND230 billion (US$10.2 million). In addition, 96 surgeons and nearly 500 medical staff have carried out charitable health checks on 12,000 patients in many provinces and cities throughout Vietnam. Through profit sharing with the Centre Médical International and corporate and personal donations, proceeds are given to the Institute to help perform roughly 25% of all cardiac surgery free of charge to indigent patients in need of congenital heart surgery. CONCLUSION: The Vien Tim Institute du Coeur has stayed true to its goal of offering high quality cardiac surgical care including congenital heart surgery to a large patient population with one quarter directed to the medically indigent. It also continues to empower and train the health care professionals locally and throughout the country. Creation and growth through this model may help provide a fully functional and financially self-sustaining institution in a developing nation.

Contemporary management of isolated chronic infrarenal abdominal aortic dissections.

OBJECTIVE: The purpose of this study was to report the presentation, treatment, and follow-up of isolated infrarenal aortic dissections. METHODS: A review of 37 patients with isolated infrarenal aortic dissections was performed. Computed tomography scans with intravenous administration of contrast material were examined for all patients; catheter-based angiography, magnetic resonance angiography, and duplex ultrasound were used selectively. In dissections associated with the development of abdominal aortic aneurysm (AAA), the aneurysm growth rate was determined by measuring the change in maximum aneurysm diameter over time and dividing that by the duration of observation. RESULTS: The majority of infrarenal abdominal aortic dissection patients were male (67.6%). Hypertension (77.1%) and hyperlipidemia (77.1%) were the most common comorbidities among these patients. Aortic atherosclerosis was present in the majority of patients (60.0%); 67.6% of dissections were discovered incidentally and were asymptomatic. The mean dissection length was 5.84 ± 4.23 cm. Concomitant AAAs were present in 48.6% of cases with an average maximum diameter of 4.38 ± 1.41 cm. The aneurysm growth rate was 1.2 mm/y. Aneurysms were significantly larger in men than in women (4.87 ± 1.31 vs 3.12 ± 0.67 cm; P = .001). Endovascular intervention was performed on 14 (37.8%) patients, open surgery was performed on 1 (2.7%) patient, and surveillance with conservative medical treatment was used for 22 (59.5%) patients. Ten patients were treated successfully with endovascular repair for progressive aneurysm expansion. At the time of intervention, the mean AAA diameter was 5.04 ± 1.39 cm. The mean growth rate for aneurysms that were intervened on was 2.3 mm/y. The mean diameter of AAAs that were not intervened on was 3.56 ± 1.04 cm. Type II endoleaks were observed in three (30%) patients who underwent endovascular repair. None of these were associated with aneurysm growth and none required reintervention. The mortality rate for endovascular intervention was 0%. The only open surgical repair performed was on a patient with a ruptured AAA, which the patient did not survive. Angioplasty with stent or stent graft placement was performed in four patients for the treatment of symptomatic arterial insufficiency resulting from aortic dissection. No patients experienced restenosis, and no reinterventions were performed. CONCLUSIONS: Isolated infrarenal aortic dissection is an uncommon vascular disease that is related to hypertension, hyperlipidemia, and atherosclerosis and may be associated with infrarenal AAA formation. The presence of dissection does not appear to increase the risk of complication or mortality for repair of concomitant aneurysm or for treatment of stenosis.

Reconstruction of "unreconstructable" critical limb ischemia with hybrid techniques.

This case describes the surgical repair of critical limb ischemia in a patient with diffuse multilevel peripheral arterial disease. It demonstrates the value of patient-specific approaches that employ hybrid endovascular and open surgical techniques to reconstruct blood flow in patients who are not ideal candidates for traditional revascularization. We detail a technique that combines endarterectomy, femoropopliteal bypass, angioplasty, and stenting. This case suggests that innovative hybrid approaches can be used to achieve limb salvage in some patients with multilevel peripheral vascular disease who would otherwise undergo primary amputation.