Atrial Septal Defect.

The 1990s have seen considerable growth in our knowledge of outcomes in patients with atrial septal defect (ASD), improved techniques for imaging and diagnosing ASD, and advances in the treatment of ASD. Exciting new surgical procedures, such as minimally invasive surgery, the Cox-Maze procedure for patients with atrial fibrillation, and lung transplantation for patients with severe pulmonary artery hypertension, are now available. In my opinion, echocardiography is the procedure of choice for the diagnosis and characterization of ASD. Children and adults with ASD should undergo surgical repair unless there are contraindications. Surgical repair "early" in life prolongs survival and may prevent atrial fibrillation. Surgical repair in "older" adults prolongs survival and alleviates symptoms but will not abolish sustained or paroxysmal atrial fibrillation. Patients with ASD and atrial fibrillation (sustained or paroxysmal) should undergo surgical repair of ASD and a Cox-Maze procedure.