[Clinical profiles, pathologic spectrum and management of atrial septal defect in patients aged 50 or over: how should it be treated?].

Clinical and hemodynamic spectrum of secundum type atrial septal defect (ASD) in patients aged 50 or over was studied. Analysis of 20 elderly patients (mean age: 73.6 years) medically treated in Tokyo Metropolitan Geriatric Hospital revealed that in the majority of patients symptoms were mild and shunt flow ratio was relatively small, accompanied by mildly elevated pulmonary arterial pressure. Autopsy studies in six patients suggested small ASD was compatible with normal life span. Analysis of 289 cases aged 50 or over, collected from 42 medical institutions, showed that 26.9% of them were asymptomatic (NYHA functional class I) and 31.3% of them had Qp/Qs ratio of less than 2.0, 20.2% of them had normal or nearly normal pulmonary arterial pressures. Only 16.6% of total cases had been treated surgically. Pulmonary hypertension and congestive heart failure inevitably limited the life span of patients with ASD, so it is clearly reasonable to close the defect before these complications develop. But in view of relatively large proportions of asymptomatic patients and/or patients with normal pulmonary arterial pressure suggestive of small ASD, conservative management may also be appropriate even in those patients aged 50 or over.