Atrial Septal Defect in the Older Patient

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Abstract
Twenty-four patients over 35 years of age with a secundum atrial septal defect (ASD) had a clinical and hemodynamic assessment prior to surgical closure and a follow-up assessment an average of 6 years afterward. All were initially in functional class III or IV. Twenty-three patients had a moderate to large left-to-right shunt. Five had elevated pulmonary vascular resistance (PVR); all had moderate to severe pulmonary hypertension. Left ventricular dysfunction (LVD) was found in 17. Following surgical closure, 22 patients showed sustained clinical improvement and were in class I or II. The mean pulmonary artery pressure fell to normal or mildly elevated values in 21. The PVR was now elevated in 14 patients, suggesting continued progression of obliterative pulmonary vascular disease. Three had small residual shunts. LVD, however, persisted after operation, which may reflect underlying myocardial pathology unrelated to the ASD. Operative closure of ASD, therefore, is recommended for disabled patients over 35, even if they have moderate pulmonary hypertension or congestive heart failure.