title: [Clinical follow-up of staged hybrid approach for patients with ventricular septal defects combined with patent ductus arteriosus and pulmonary hypertension].
abstract: OBJECTIVE
  To evaluate the safety and efficacy of staged hybrid approach in treating ventricular septal defect (VSD) patients combined with patent ductus arteriosus (PDA) and pulmonary artery hypertension (PAH).
  
  
  METHODS
  From July 2004 to July 2009, 22 VSD patients with PDA and PAH were enrolled and received staged hybrid approach treatment (transcatheter PDA occlusion and elective open surgery for VSD several days after PDA occlusion). All patients were followed up to examine rhythm change, residual shunt, shape of occlude, possible valve regurgitation, and aortic stenosis by echocardiography.
  
  
  RESULTS
  After transcatheter PDA occlusion, pulmonary arterial systolic pressure decreased from (76.2 ± 25.8) mm Hg (1 mm Hg = 0.133 kPa) to (55.4 ± 20.6) mm Hg (P = 0.005), mean pulmonary artery pressure decreased from (53.5 ± 23.5) mm Hg to (36.2 ± 17.8) mm Hg (P = 0.049), total pulmonary resistance decreased from (8.2 ± 4.9) wood units to (6.9 ± 4.3) wood units (P = 0.037), and pulmonary-to-systemic flow ratio (Qp/Qs) increased from 2.8 ± 2.3 to 3.4 ± 1.7 (P = 0.045) post transcatheter interventional PDA occlusion. After VSD repair, pulmonary arterial systolic pressure decreased from (64.5 ± 22.3) mm Hg to (43.1 ± 18.9) mm Hg (P = 0.001) and mean pulmonary artery pressure decreased from (40.2 ± 18.7) mm Hg to (29.5 ± 15.8) mm Hg (P = 0.040). There was no death or right heart failure during the follow-up.
  
  
  CONCLUSIONS
  Staged hybrid approach is an effective and safe strategy for treating VSD patients with PDA and PAH.
authors.affiliation: Department of Cardiovascular Surgery, Fourth Military Medical University, Xi'an 710032, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Yang
authors.forename: Li-fang
authors.initials: LF
authors.lastname: Yang
authors.forename: Jin-cheng
authors.initials: JC
authors.lastname: Liu
authors.forename: Shi-qiang
authors.initials: SQ
authors.lastname: Yu
authors.forename: Jian
authors.initials: J
authors.lastname: Zuo
authors.forename: Zhen-xiao
authors.initials: ZX
authors.lastname: Jin
authors.forename: Tao
authors.initials: T
authors.lastname: Chen
authors.forename: Ding-hua
authors.initials: DH
authors.lastname: Yi
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.forename: Jun
authors.initials: J
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D002648:Child; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000601:surgery*; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000601:surgery*; D008297:Male; D055815:Young Adult