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The Clinical Course in Muscular Subaortic Stenosis: A Retrospective and Prospective Study of 60 Hemodynamically Proved Cases

A. G. ADELMAN, M.D.; E. D. WIGLE, M.D., F.A.C.P.; N. RANGANATHAN, M.B.B.S.; G. D. WEBB, M.D.; B. S. L. KIDD, M.D.; W. G. BIGELOW, M.D.; and M. D. SILVER, M.B.B.S., Ph.D.
[+] Article and Author Information

Supported by the Ontario Heart Foundation, Toronto, Ontario, Canada.

▸Requests for reprints should be addressed to Allan G. Adelman, M.D., Cardiovascular Unit, Toronto General Hospital, 101 College St., Toronto 101, Ontario, Canada.


Toronto, Ontario, Canada


Ann Intern Med. 1972;77(4):515-525. doi:10.7326/0003-4819-77-4-515
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A retrospective and prospective analysis of the clinical course of 60 hemodynamically proved cases of muscular subaortic stenosis showed that in 41 (68%) the murmur was the first evidence of the disease. Fifty-six of the 60 patients (93%) developed symptoms (Class II, New York Heart Association) an average of 10 years after the murmur was first heard, and 40 (66%) deteriorated to Class III-IV an average of 5 years after the onset of symptoms. Of 28 untreated or propranolol-treated patients, 4 (14%) died of the disease. This experience indicates that muscular subaortic stenosis is a progressive disease once symptoms start. Most patients experienced symptomatic improvement with propranolol therapy. However, only 25% of Class III-IV patients with left ventricular outflow tract obstruction at rest maintained this improvement into the second year of therapy, whereas 75% of patients in Class III-IV who underwent ventriculomyotomy have had sustained symptomatic improvement.

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