XXXX : defining surgical and nonsurgical outcomes.

@entity1 @entity3585 @entity7196 @entity3297 @entity850 @entity204
BACKGROUND: @entity7196 is a rare stenotic lesion of the left ventricular outflow tract (LVOT). We characterized the natural history of the disease and the effect of surgical intervention. METHODS: Ninety-five @entity1 diagnosed with @entity7196 between 1976 and 2006 were studied. Procedural and repeated echocardiography reports were analyzed. RESULTS: @entity850 morphology (localized, 82%; diffuse, 18%) was independent of @entity3297 (n = 59, 62%). The risk of open operation (n = 47) was 46% +/- 6% at 10 years. Increased risk of operation was associated with higher baseline LVOT peak gradients (p < 0.001), smaller minimum LVOT z scores (p < 0.01; thresholds > 50 mm Hg and < -3, respectively), and the absence of @entity3297 (p = 0.01). @entity1 who did not undergo operations had gradually reducing LVOT gradients and enlarging ascending aorta z scores over time. Persistently small minimum LVOT z scores and higher gradients were associated with @entity1 who required an operation. Operation resulted in persistent relief of @entity3585 and accelerated increases in ascending aorta dimensions. Overall survival was 94% +/- 3% and 85% +/- 7% at 10 and 15 years and was similar for surgical and nonsurgical groups. No independent risk factors for @entity204 were identified on univariate or multivariable analysis. CONCLUSIONS: Many @entity1 -particularly those with @entity3297 -show regression of @entity850 without intervention. @entity1 who undergo operation have high LVOT gradients and smaller LVOT z scores that do not improve over time. Surgical intervention alters the natural history: @entity3585 is relieved and does not recur, and ascending aortic dimensions progressively enlarge towards normal values.
