Background: Intra-cardiac masses are rare and challenging lesions with an overall incidence ranging of 0.02–0.2%. Minimally invasive approaches have been recently introduced for surgical resection of these lesions. Here, we evaluated our early experience using minimally invasive techniques in addressing intra-cardiac lesions. Methodology: This is a retrospective descriptive study conducted between April 2018 to December 2020. All patients were diagnosed with cardiac tumors and treated via a right mini-thoracotomy with cardiopulmonary bypass through femoral cannulation at King Faisal Specialist Hospital and Research Centre, Jeddah. Results: Myxoma was the most common pathology representing 46% of cases followed by thrombus (27%), leiomyoma (9%), lipoma (9%) and angiosarcoma (9%). All tumors were resected with negative margins. One patient was converted to open sternotomy. Tumor locations were in the right atrium, left atrium, and left ventricle in 5, 3, and 3 patients, respectively. The median ICU stay was 1.33 days. The median length of hospitalization was 5.7 days. There was no 30-days hospital mortality recorded in this cohort. Conclusion: Our early experience shows that minimally invasive resection can be performed safely and effectively for intra-cardiac masses. The minimally invasive approach using a mini-thoracotomy with percutaneous femoral cannulation can be an effective alternative in resecting intra-cardiac masses that achieves clear margin resection, quick post-operative recovery, and low rates of recurrence for benign lesions.

Background: The management of mitral valve disease in young children is challenging. Mechanical mitral valves could provide long-term durability; however, the need for anticoagulation increases the risk profile of mechanical valves. We report our experience in mechanical mitral valve replacement (MVR) in children under 2 years of age and evaluate factors affecting the outcomes. The study included all patients younger than 2 years who underwent mechanical MVR between 2000 and 2023. The study outcomes were mitral valve reoperation, bleeding, valve-related thrombosis, and survival. Results: Twenty-three patients were included, with a mean age of 10.2 ± 5.9 months. The mitral valve sizes ranged from 16 to 25 mm, and 6 (26%) were placed in the supra-annular position. Complete heart block occurred in seven patients (30%), and operative mortality occurred in three patients (13%). Postoperative warfarin was used in 17 patients (74%). After discharge, bleeding occurred in five patients (22%), four were managed conservatively, and one had intracranial hemorrhage treated with craniotomy. Nine patients (39%) had valve-related thrombosis; two underwent reoperation, while seven were treated with alteplase in 26 patients. Valve-related thrombosis was more common in patients with supra-annular valves (p < 0.001) and in those who were not on warfarin (p < 0.001). A total of seven patients (30%) underwent redo MVR, and redo was more common in young patients (p = 0.029) and in patients with supra-annular valves (p < 0.001). Survival of the whole cohort was 73% at 5 years. Among the annular position group, 5-year survival was 88%, while among the supra-annular position group, survival was 50% after 3 months and 25% after 14 months (p = 0.009). Conclusions: Mechanical MVR in children younger than 2 years is associated with high complication rates, including thrombosis and bleeding. The supra-annular valve position appears to be a risk factor for thrombosis and reoperation. Anticoagulation with warfarin remains challenging. However, further studies evaluating alternative options are needed. Graphical

Background: There is a direct relationship between the degree of trainees’ satisfaction and their productivity. The Saudi Board of Cardiac Surgery is a new training program established by the Saudi Commission for Health Specialties. As a result, we aimed to provide helpful information and data in order to improve the overall quality of the local cardiac training program. This is the first study to look at how satisfied residents are with the Saudi cardiac surgery training program. Results: The study included 55.3% central region residents (N = 26), 31.9% western region residents (N = 15), and others from other regions, resulting in a total of 47 participants out of 60 with a 78.3% response rate. Only 42.6% of all residents were satisfied with their training in the Saudi Board of Cardiac Surgery program, 23.4% were neutral, and 34.0% were dissatisfied with the program. The most essential area for improvement was operative experience (63.8%), followed by workplace climate (8.5%) and mentorship (6.4%), whereas the area least in need of improvement was research opportunities (2.1%). Conclusions: Our results indicate a decline in satisfaction level with the training program. In reference to our findings, implementing simulation-based surgical learnings and providing more frequent exposure to Boot Camp experience in cardiac surgery is recommended. Adequate and constant mentoring, and constructive feedback, represent a valuable resource for improvement theoretically and surgically.

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease presenting beyond the neonatal period. Since its first comprehensive description by Étienne-Louis Fallot in 1888, the management of TOF has evolved remarkably – from a universally fatal condition to one with high survival and long-term quality of life. The introduction of the Blalock–Taussig shunt in 1944 provided the first effective surgical palliation by increasing pulmonary blood flow. In the 1950s, the development of cardiopulmonary bypass enabled complete intracardiac repair, which soon became the definitive treatment. Subsequent decades saw refinements in surgical technique, including the adoption of the transatrial-transpulmonary approach and pulmonary valve-sparing strategies, aimed at preserving right ventricular (RV) function. Early primary repair, now typically performed in infancy, has become the standard of care in most centers. Despite these advances, late complications such as pulmonary regurgitation, RV dilation, arrhythmias, and reinterventions remain common, necessitating lifelong follow-up. Contemporary management includes the use of multimodality imaging, transcatheter pulmonary valve replacement (TPVR), and tailored surgical planning. Emerging technologies such as artificial intelligence and computational modeling hold promise for further improving individualized care. This review outlines the historical milestones, current best practices, and future directions in the surgical treatment of TOF, highlighting its transformation from a fatal diagnosis to a survivable chronic condition requiring multidisciplinary, lifelong care.

Introduction Medical undergraduates' educational programs and clinical experiences are important factors in determining their preferred future career path. Unfortunately, the cardiac surgery specialty is experiencing a decline in medical graduates due to many influencing factors as a lack of involvement with the cardiac surgery specialty and a lack of training centers. A detailed evaluation of the student's knowledge and perceptions about cardiac surgery is required to assess the career options in a specialty like cardiac surgery. This study aims to evaluate medical students’ knowledge and perceptions of the cardiac surgical specialty. Methodology This is a cross-sectional study that was approved by the institutional research board of Umm Al-Qura University. Adapting a previously published questionnaire data to fit our scope and aims. Necessary adjustments were made adhering to the cardiac surgery experts' instructions. Data was collected through an electronic survey by Google Forms and distributed through social media apps. Results A total of 637 students participated in the study. The majority (75.2%) admitted to having little knowledge of the specialty of cardiac surgery, and 62.8% reported no interest in it. In addition, 88.9% had never done a cardiac surgery rotation before. One of the top concerns of becoming a cardiac surgeon (45.2%) was the amount of time spent studying and working. Conclusion The findings of our study highlight the value of using innovative and targeted learning methods for medical students to enhance their knowledge and pique their interest in cardiac surgery since it was evident that there was a misperception regarding the scope of cases dealt with by cardiac surgery as opposed to other surgical subspecialists.