Atrial Septal Defect in the Aged

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Abstract
The clinical and pathologic findings in two cases of atrial septal defect, aged 84 and 72 years, are presented. The findings in these cases are combined with those in 16 cases of atrial septal defect over age 65, confirmed at post mortems, found in the literature. The differences between the findings in the aged and younger individuals were increased incidence in the aged, of males, and of angina, atrial fibrillation and flutter, of higher pulse and blood pressures, and increased heart weight. Pulmonary hypertension and cyanosis were less frequent in the aged. It is concluded that cases of atrial septal defect uncomplicated by pulmonary hypertension and with persistent regular sinus rhythm or a late onset of atrial fibrillation or flutter, may survive to advanced ages. Over age 65, coronary artery disease, hypertension, and changes in aortic elasticity and caliber will cause an increased incidence of angina, higher pulse and blood pressures and increased heart weight. Nevertheless, the clinical picture of atrial septal defect in the aged is sufficiently similar to that found in younger individuals to permit a high degree of clinical accuracy of diagnosis. The two oldest cases both had defects high in the atrial septum above the fossa ovalis.