Abstract: To the Editor:We report two cases of hybrid approach by combining percutaneous balloon pulmonary valvuloplasty (PBPV) and off-pump coronary artery bypass grafting (OPCABG).A 68-year-old male was diagnosed congenital pulmonary stenosis (PS) and unstable angina.He had a history of chronic obstructive pulmonary disease (COPD).Echocardiography revealed dilated pulmonary artery branch and severe valvular PS.Transvalvular peak systolic pressure gradient (PG) was 64 mmHg (1 mmHg =0.133 KPa).