Life expectancy with atrial septal defect. Influence of complicating pulmonary vascular disease

Of 48 patients with secundum atrial septal defects diagnosed by cardiac catheterization from 1945 to 1956, 29 (60%) were still alive in 1966. Survival was markedly influenced by the presence of complicating pulmonary vascular disease. Twenty-one of 23 patients with normal pulmonary vascular resistance were still alive in 1966. However, only five of 20 patients with pulmonary vascular disease were alive (average age, 50). Six of these 20 patients died at surgery, and nine of their heart disease (average age, 41). Catheterization during the follow-up period showed that severe pulmonary vascular disease had developed in two patients. The impossibility of predicting in which patients severe pulmonary vascular disease will develop, combined with the prohibitive surgical risk that it presents, suggests that all atrial defects without pulmonary vascular disease should be surgically corrected.