A comparison of surgical and medical therapy for XXXX in adults.

@entity1 @entity712 @entity1031 @entity118 @entity943
BACKGROUND: The surgical closure of an @entity118 is frequently recommended for @entity1 over 40 years of age. However, the prognosis for such @entity1 with unrepaired defects is largely unknown, and the outcome for @entity1 operated on after the fourth decade of life has not yet been compared with that for medically treated @entity1 in a controlled follow-up study. METHODS: In a retrospective study, we examined the clinical course of 179 consecutive @entity1 with isolated @entity118 diagnosed after the age of 40. The 84 @entity1 (47 percent) who underwent surgical repair were compared with the 95 @entity1 (53 percent) who were treated medically. The mean (+/-SD) follow-up period was 8.9 +/- 5.2 years (range, 1 to 26). RESULTS: Multivariate analysis revealed that surgical closure of the defect significantly reduced mortality from all causes (relative risk, 0.31; 95 percent confidence interval, 0.11 to 0.85). The adjusted 10-year survival rate of surgically treated @entity1 was 95 percent, as compared with 84 percent for the medically treated @entity1 . In addition, surgical treatment prevented functional deterioration, as measured by the New York Heart Association class (relative risk, 0.21; 95 percent confidence interval, 0.08 to 0.55). However, the incidence of new @entity943 or of cerebrovascular insults in the two groups was not significantly different. CONCLUSIONS: The surgical repair of an @entity118 in @entity1 over 40 years of age, as compared with medical therapy, increases long-term survival and limits the deterioration of function due to @entity712 . However, surgically treated @entity1 should be followed closely for the onset of @entity943 so as to reduce the risk of @entity1031 complications.
