Atrial septal defects in the older patient simulating acquired valvular heart disease

M‐mode and two‐dimensional contrast echocardiography in adult patients with atrial septal defects

“…Atrial septal defect is a common form of congenital heart defect in both children and adults. While the diagnosis is relatively straightforward in children, other considerations must be borne in mind in the older age groups, where, moreover, physical and radiological signs may be nonspecific and misleading (Kuzman and Yuskis, 1965;Perloff, 1980). Until recently, positive dem-onstration of the defect required invasive catheterization and angiography.…”

Severe mitral regurgitation: A common occurrence in the aging patient with secundum atrial septal defect

“…While the reported 5% incidence of severe MR in the secundum ASD population provides some clinical perspective to this association, previous reports have not emphasized the increased frequency of severe MR specifically in the older patient, which was 15% in our patients over age 50 years. Only minimal corroboration of our findings from a review of the literature was possible because few reports provided sufficient data to judge the severity of MR. Studies in which data were available (Boucher et aI., 1979;Hynes et al, 1974;Kuzman andYuskis, 1965: Leachman el al., 1976;Parnsingha et al, 1977;Welch et al, 1966), indicate that severe MR was reported most often in middle-aged or older ASD patients.…”

“…Our observation of the significantly higher frequency of severe MR in older patients with ASD supports these explanations because in both the mitral valve abnormality would be expected to be more severe with long duration. The relationship between mitral valve prolapse, which is so common in ASD, and severe MR remains unclear and requires prospective study, although with chronic prolapse mitral deformity, fibrosis and incompetence are not inconsistent (Edwards and Burchell, 1958;Kuzman and Yuskis, 1965;Levy and Edwards, 1962;Okada et 01., 1969;Pomerance and Davies, 1975). It is possible that some patients had rheumatic valvulitis.…”

“…Awareness of the frequent coincidence of severe MR in older ASD patients has clinical importance. In patients with ASD, the magnitude of MR is often underestimated because the ASD allows decompression of the regurgitant left ventricular volume; MR may even be inapparent preoperatively (Bashour and Simmons, 1958;Boucher et 01., 1979;Hynes et 01., 1974;Kirklin and Pacific, 1978;Kuzman and Yuskis, 1965;McDonald et 01., 1971). However, following ASD closure, left atrial decompression across the ASD is no longer possible, thus patients with severe MR develop symptoms of pulmonary venous hypertension.…”

Persistent Cardiac Ostium Primum: A Diagnostic Dilemma in the Aged*

“…Braudo and associates' (9) analysis of 80 postmortem cases in patients of all age brackets revealed only 35 deaths attributable directly to the congenital cardiac defect; the other deaths were due to non‐cardiac disorders. Thus other aspects besides cardiac failure deserve special attention, including the high incidence of associated non‐cardiac anomalies, recurrent pulmonary infections, chronic bronchitis and emphysema, acquired valvulitis (rheumatic and bacterial), and thromboembolic phenomena (8, 10–12). It is not surprising that surgical intervention in the elderly patients with an atrial septal defect, particularly of the ostium primum variety, is associated with a relatively high morbidity and mortality (5–6).…”