We reviewed our experience of tricuspid valve surgery for tricuspid regurgitation in hypoplastic left heart syndrome (HLHS) in terms of surgical timing, surgical procedures and long-term results. From May 1991 to July 2010, 105 classic HLHS patients underwent cardiac surgery, 28 of whom underwent a total of 31 tricuspid valve surgical procedures. Tricuspid valve surgery was performed in cases of moderate or more tricuspid regurgitation (TR). Type of the first tricuspid valve surgery was as follows : Annuloplasty in 15 patients, annuloplasty+commissure closure in 7 patients, commissure closure in 2 patients, edge-to-edge repair in 2 patients, tricuspid valve replacement in 2 patients. Three patients underwent re-operation because of progression of TR. Two of them underwent tricuspid valve repair and one of them underwent tricuspid valve replacement. Follow-up was 60.1±53.0 months. Freedom from moderate or more TR after tricuspid valve surgery was 50.9% at 1 year, 42.0% at 3 years, 36.0% at 5 years. Among 17 patients who achieved total cavopulmonary connection procedure, 35.2% of patients had moderate or more TR, but central venous pressure (9.1±2.2 mmHg), cardiac index (3.5±6.8 l/min/m²), arterial oxygen saturation (94.2±1.7%) showed as good hemodynamics after a Fontan procedure as non-tricuspid valve surgery cases. Appropriately timed aggressive tricuspid valve surgery yielded as good long-term results as HLHS without tricuspid valve surgery.

In 1999, an insecticide-treated net (ITN) distribution project was started in several malaria-endemic villages in Lao P.D.R., namely Vientiane, Bolikhamxay and Khammouanne Provinces. After the completion of the project, it was found that the ITNs were effective for malaria control based on the analysis of the slide positivity rate for malaria parasites between 1999 and 2000 [6]. We conducted malariometric, entomological and KAP surveys in 2005-06 to confirm the status of malaria and to determine the effectiveness of ITNs in three different socioepidemiological areas (near city, rural and remote), represented by the Xebangfay and Boualapha districts, Khammouanne Province.
A marked decrease in the annual malaria incidence and slide positivity rate was noted from 1999 to 2006 in the two districts. The malaria prevalence was significantly reduced in near city areas (5.6%-10.7% in 1999 to 0% in 2005-06) and rural areas (21.4%-50.9% in 1999 to 0%-1% in 2005-06). Twelve positive cases were recorded in remote areas (3.4 - 7.7% in 2006).
The illiteracy rate was significantly higher among the respondents in the remote (83.9%) than among those in the near city (32.7%) and rural (54%) areas. In all areas, more than 50% of the villagers indicated that they were not aware of malaria. Similarly, about 60% of the respondents were found to have incorrect knowledge concerning malaria transmission. In remote, 40.9% of the respondents were aware of the methods to prevent malaria infection and 49.5% used mosquito nets throughout the year, rates significantly lower than the corresponding rates in near city and rural. The density of persons per net in remote (3.1-5.9) was considerably higher than that in near city (1.8-2.1) and rural (1.2-2.7). Malaria vector mosquitoes, such as An. minimus and An. nivipes were collected by human-baited adult collection, and cow-baited and CDC light traps. The results of the analysis suggested that the lower the number of persons per net the more effective the reduction of malaria morbidity in these areas. It is imperative that ITN distribution and health education regarding malaria be strengthened, especially in remote, but also in other areas.