Excerpt

The population of adults with congenital heart disease has dramatically increased. Atrial septal defect (ASD) is the most common lesion (20 to 30%) in adults; 80% is a secundum ASD. Many patients with isolated ASD are diagnosed in adulthood because most children with ASD are free from overt symptoms. Diagnosis is often accidental. Clinical symptoms including palpitations, exertional dyspnoea, and fatigue are frequently observed beyond the fourth decade. Life expectancy is overall reduced but survival is much better than reported in early studies. With increasing age, pulmonary arterial pressures (PAP) usually increase and atrial arrhythmias become more common. Systemic embolism may be caused by paradoxical embolism (rare) or atrial fibrillation. …