title: Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension: hemodynamic outcomes.
abstract: OBJECTIVE
  The purpose of the present study was to study the midterm hemodynamic outcomes of unidirectional valved patch closure of ventricular septal defects (VSDs) in patients with VSD and pulmonary arterial hypertension (PAH).
  
  
  METHODS
  From January 2006 to January 2012, 20 patients with VSD with PAH and a pulmonary vascular resistance index >8 Wood units underwent VSD closure with a unidirectional valved patch using the technique previously described by us. Of these, 13 patients agreed to follow-up cardiac catheterization and were studied at a mean follow-up of 34.7 ± 18.6 months (range, 2-56). The mean age of these 13 patients was 8.5 ± 4.4 years (range, 2-19; median, 9), and the mean preoperative systemic saturation was 94.1% ± 3.4% (range, 87-99; median, 95.0) The mean preoperative pulmonary artery systolic pressure was 96.2 ± 13.6 mm Hg (range, 75-115; median, 103.0), and the mean preoperative pulmonary vascular resistance index was 10.0 ± 2.1 Wood units (range, 8.0-15.1; median, 9.3).
  
  
  RESULTS
  At follow-up cardiac catheterization, the mean systemic saturation had increased to 98.92%. The pulmonary vascular resistance index had decreased significantly to 5.8 ± 2.1 Wood units (P = .02). A significant decrease was seen in the pulmonary artery systolic, diastolic, and mean pressures (P = .000), and none of the patients had severe PAH. No patients died, and all patients were in New York Heart Association class I.
  
  
  CONCLUSIONS
  Unidirectional valved patch closure of VSD is a promising technique for patients with a large VSD and severe PAH. It had a favorable effect on the immediate, early, and midterm clinical outcomes and hemodynamic parameters.
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. Electronic address: sachintalwar@hotmail.com.
authors: Sachin
authors: S
authors: Talwar
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Vikas Kumar
authors: VK
authors: Keshri
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Shiv Kumar
authors: SK
authors: Choudhary
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Saurabh Kumar
authors: SK
authors: Gupta
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Sivasubramanian
authors: S
authors: Ramakrishnan
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Anita
authors: A
authors: Saxena
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Shyam Sunder
authors: SS
authors: Kothari
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Rajnish
authors: R
authors: Juneja
authors: Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
authors: Guresh
authors: G
authors: Kumar
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Balram
authors: B
authors: Airan
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult