XXXX in the spectrum of @entity474 . Solutions may be complex and palliative.

@entity1 @entity1757 @entity474 @entity475 @entity1129 @entity340
From July 1982 through September 1994, 19 @entity1 had operative treatment of @entity475 associated with an @entity474 . Specific diagnosis were septum primum defects in 7, Rastelli @entity1129 in 6, transitional defects in 4, inlet @entity1757 with malattached chordae in 1, and tetralogy of Fallot with Rastelli type C defect in 1. Twenty-seven operations for @entity475 were performed. Surgical treatment of the outlet lesion was performed at initial @entity474 repair in 3 @entity1 and in the remaining 16 from 1.2 to 13.1 years (mean 4.9 years, median 3.9 years) after repair. Eighteen of the 19 @entity1 had fibrous resection and myectomy for relief of obstruction. Seven @entity1 had an associated left @entity340 . One @entity1 received an apicoaortic conduit. Seven @entity1 (36.8%) required 8 reoperations for previously treated @entity475 . Time to the second procedure was 2.8 to 7.4 years (mean 4.9 years). Follow-up is 0.4 to 14.0 years (median 5.6 years). Six-year actuarial freedom from reoperation is 66% +/- 15%. The angle between the plane of the outlet septum and the plane of the septal crest was measured in 10 normal hearts (86.4 +/- 13.7) and 10 hearts with @entity474 (22.2 +/- 26.0; p < 0.01). The outflow tract can be effectively shortened, widened, and the angle increased toward normal by augmenting the left side of the superior bridging leaflet and performing a fibromyectomy. CONCLUSION: Standard fibromyectomy for @entity475 in @entity1 with @entity474 leads to a high rate of reoperation. Leaflet augmentation and fibromyectomy may decrease the likelihood of reoperation.
