Strengthening congenital cardiac care in Vietnam: opportunities for system-level reform.

Critical CHD refers to life-threatening cardiac anomalies present at birth that require surgical or catheter-based intervention within the first year of life. Without punctual diagnosis and treatment, these conditions can result in significant morbidity or mortality. In high-income countries like the United States (U.S.), early detection and management of Critical CHD have been greatly improved through universal prenatal screening, pulse oximetry screening, regionalised care, and subspecialty training. In contrast, Vietnam, a low- and middle-income country, faces persistent challenges. The absence of newborn screening policies and limited prenatal detection infrastructure leads to delayed diagnoses. Paediatric cardiac expertise and surgical services are largely confined to urban centres, leaving rural areas underserved. Vietnam also lacks national CHD registries, standardised referral pathways, and consistent training programmes, impeding quality improvement and equitable access. This manuscript compares the U.S. and Vietnamese Critical CHD systems, highlighting structural, infrastructural, and workforce-related disparities. We identify barriers, key areas for intervention, and offer targeted strategic considerations to address these discrepancies. We strongly believe that efforts to implement universal newborn screening, develop regional cardiac hubs with mandatory outreach support to rural proximity, expand workforce training, invest in ICU infrastructure, and establish national data systems are of immediate need. These reforms could significantly improve survival and outcomes for children with Critical CHD in Vietnam and inform similar efforts in other low- and middle-income countries.