Atrial septal defect in patients over 45 years of age. Merits of surgical versus medical therapy.

Abstract

Surgical closure was carried out in 15 and in 19 of the 34 patients studied were treated medically of those undergoing surgery, 8 died. Two had increasing disability after surgery, while 7 obtained benefit from the operation. Of those not operated upon 11 have minimal or no symptoms despite an average age 10 yr. in excess of the surgical group. Only 3 patients in this group died from cardiovascular complications; 3 were lost to follow-up. Merits of surgery in the older adult with atrial septal defect were reviewed. In patients with severe pulmonary hypertension, the operative risk is high and the post-operative morbidity may be disabling. Conservative management may also be appropriate for the occasional asymptomatic elderly patient. Surgery appears to offer greatest benefit to the progressively symptomatic adult with normal or mild to moderate increases in pulmonary arterial pressure.