Recognition of Congenital Heart Disease in the Fifth to Eighth Decades of Life

Abstract

Fifty patients with congenital heart disease in the 5th to 8th decades of life have been reviewed. Atrial septal defects were the most common lesions and were compatible with long life. Symptoms may occur late but are often rapidly progressive. Despite large left-to-right shunts, pulmonary artery pressures are often normal or only moderately increased. Misdiagnoses are common. Atrial septal defects are confused most frequently with rheumatic heart disease. A diagnosis of mitral stenosis or mitral insufficiency was made in over 50% of this group before admission to our hospital. Some patients with a patent ductus arteriosus may survive to old age. The pulmonary artery pressure tends to be higher in this group than in those with atrial defects with a similar magnitude of left-to-right shunt. Patients with moderately severe pulmonic stenosis may be asymptomatic. Patients with ventricular septal defects show a high attrition rate before 40 years of age, and those surviving past 40 seem to have small and dynamically insignificant lesions. Cyanotic congenital heart disease is very rare after 40 years of age. Age alone should not be a deterrent to surgical correction of congenital heart defects. Moderate pulmonary artery hypertension is not a contraindication either, and was reversible in a number of our patients. In view of these findings, it would seem important to consider congenital heart disease in the differential diagnosis of all patients with suspected cardiac disease, even in individuals of middle age and beyond. An accurate diagnosis should be sought, since surgical correction may be possible with considerable benefit to the patient.