Atrial septal defect in the adult: Clinical findings before and after surgery

The adult with atrial septal defect (ASD) is usually minimally symptomatic but symptoms increase with age. In many patients the diagnosis is made while evaluating seemingly unrelated disorders. The most frequent symptoms are dyspnea and palpitations, though the latter is poorly correlated with serious arrhythmias. The most common auscultatory signs are pulmonary ejection murmur and a widely-split and fixed second heart sound. The electrocardiogram, chest x-ray, and M-mode echocardiogram are valuable screening tests; however, occasionally they may appear normal. Surgical correction has low mortality and morbidity. Most adults with ASD have persistent echocardiographic abnormalities following surgery, although this appears unrelated to symptomatic improvement and functional capacity. Global left ventricular dysfunction assessed by contrast ventriculography appeared most related to the presence of significant mitral regurgitation. The prevalence of supraventricular and ventricular arrhythmias does not appear to change for months to years after surgery.