title: Unidirectional monovalve homologous aortic patch for repair of ventricular septal defect with pulmonary hypertension.
abstract: BACKGROUND
  Severe pulmonary hypertension is a common complication of congenital cardiac defects with large left to right shunt, and the closure of a large ventricular septal defect (VSD) with elevated pulmonary vascular resistance (PVR) is associated with significant morbidity and mortality. A unidirectional monovalve homologous aortic patch was designed to close the large VSD with severe pulmonary hypertension in an effort to decrease the morbidity and mortality.
  
  
  METHODS
  Twenty-seven patients (mean age, 15.0 +/- 5.6 years) with large VSD with severe pulmonary hypertension (pulmonary vascular resistance, 15.2 +/- 3.8 Wood units) were repaired with a unidirectional monovalve homologous aortic patch. According to body surface area and the preoperative arterial oxygen saturation, the monovalve homologous aortic patches were fenestrated on the aortic wall with a diameter of 4 to 8 mm.
  
  
  RESULTS
  Two patients died of pulmonary hypertensive crisis and cardiac arrest postoperatively. All of the survival patients were followed up (5 months to 10 years) and the cardiopulmonary function was well improved with no late death. Obvious opening and closing of the monovalve was detected by early postoperative echocardiography in seven patients. A small amount of right to left shunt was detected in three patients three months after operation, and in two of them the shunt still existed three years after operation.
  
  
  CONCLUSIONS
  Closure of a large VSD in patients with severe pulmonary hypertension could be performed with low morbidity and mortality when a unidirectional monovalve homologous aortic patch was used and the long-term result was satisfactory.
authors.affiliation: Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.forename: Shuming
authors.initials: S
authors.lastname: Wu
authors.forename: Jiali
authors.initials: J
authors.lastname: Liang
authors.forename: Guangfu
authors.initials: G
authors.lastname: Zhang
authors.forename: Guanhua
authors.initials: G
authors.lastname: Jiang
authors.forename: Min
authors.initials: M
authors.lastname: Zhou
authors.forename: Xiangling
authors.initials: X
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000637:transplantation*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D008297:Male; D014184:Transplantation, Homologous; D016896:Treatment Outcome