The natural history of small atrial septal defects: Long-term follow-up with serial heart catheterizations

Ostium Secundum Atrial Septal Defect in the Elderly

“…The natural history of ASD is well known. Nevertheless, the surgical closure of the defect in childhood hinders long‐term studies on large populations 7–9 . However, low mortality rates have been reported for the first two decades, 0.6% and 0.7% per annum.…”

“…Although several studies proved an age‐related trend towards progression of right ventricular hypertrophy and dilation, right atrial and pulmonary arterial pressure, and left to right shunt, 21,23,25 other prospective studies performed by serial heart catheterizations showed a relative hemodynamic stability of ASD 4,7 …”

“…Neither etiology of POVD nor factors linked to its rate of progression have been defined so far 27 . Pulmonary hypertension, race, gender, and age have been related to the development of POVD; nevertheless, none of these factors can in itself justify the onset of POVD whose etiology is probably multifactorial 7,22,24,26–31 …”

Surgical and Interventional Therapies for Pulmonary Arterial Hypertension

“…Small VSDs produce only a small left to right shunt with Qp:Qs < 1.5 and usually do not cause symptoms or hemodynamic changes over time. 84 In contrast, moderate-sized and large VSDs measuring over 1 cm 2 or larger than 75% of the aortic diameter are associated with large left to right shunts leading to RV hypertrophy and progressively worsening PAH over time.…”

“…The size of the defect and the PVR:SVR ratio determines the degree of symptoms: large VSDs generally present with congestive heart failure in infancy but patients with single small and moderate-sized VSDs may survive into adulthood with relatively few symptoms. 84 Perimembranous defects lie adjacent to the tricuspid annulus in the region of the anteroseptal commissure and account for 80% of VSDs whereas muscular VSDs account for only 5 to 20% and are usually located in the midmuscular region. Subpulmonary defects account for 5 to 10% and are located immediately beneath the pulmonary and aortic valves.…”