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Atrial septal defect (ASD), one of the most common types of congenital heart disease, can be diagnosed and treated early in life but frequently remains undetected until adulthood.1 Over time, the haemodynamic complications of a simple ASD depend on the size of the defect, right and left ventricular compliance, and right and left atrial pressures. A clinically significant ASD with chronic left-to-right shunting often leads to arrhythmias, right-sided heart failure and/or pulmonary arterial hypertension. In addition, as highlighted almost 60 years ago in Dexter’s classic essay, patients with ASD and long-standing shunting—as it occurs with aging—seem to develop left ventricular dysfunction.2
Presenting symptoms in adulthood are commonly palpitations and exercise intolerance. Irrespective of symptoms, according to European Society of Cardiology (ESC) guidelines, ASD closure is the treatment of choice for haemodynamically significant defects with evidence of right ventricle volume overload in the absence of fixed pulmonary hypertension or left ventricular disease.1 In paediatric patients and young adults, transcatheter closure is the first treatment strategy in anatomically feasible cases. However, the benefits of this procedure in elderly people are less clear as only few data are available in patients >60 …
Contributors All authors contributed to this editorial.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.