Closure of atrial septal defects: is the debate over?

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Abstract
See doi:10.1016/S1095-668X(02)00383-4for the article to which this editorial refers. Debate regarding the optimal management of the patient with an atrial septal defect (ASD) has occupied many pages of the cardiology journals despite it being one of the most common and‘simple’ congenital lesions.1 Three questionscrystallize the debate: (1) Who should have their ASD closed? (2) When should it be closed? and (3) How should it be closed? Before discussing these issues we should clarify what is meant by the term ASD. In the context of this discussion the majority are isolated secundum defects without significant fixed pulmonary hypertension. Sinus venosus defects can also be included with a few provisos, but primum defects anddefects associated with complex congenital heart disease form a different entity and will not be discussed further. The atrial septal defect is a progressive lesion. There are few sizeable natural history studies from an era of modern medical therapy, but historical cohorts suggest long-term sequelae of right heartfailure, functional decline, arrhythmia, possible stroke and early death.2 To justify intervention, of any description, therapy must be shown to ameliorate these sequelae with a favourable risk:benefit profile. In this issue, Roos-Hesselink et al. report on the excellent outcome associated with surgical repair of atrial septal defects during childhood.3 Over 21–33 years of follow-up …

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