Congenital Heart Disease in Middle‐aged Adults

A clinical and haemodynamic survey is given of 112 patients above the age of 40 years with congenital heart diseases studied at a Cardiological Centre in Norway from 1960 to 1965. Atrial septal defect was found in 61, ventricular septal defect in nine, patent ductus arteriosus in 16, pulmonic stenosis in 14, coarctation of the aorta in 11 and Ebstein's anomaly of triscuspid valves in one patient. The sex distribution was on the whole similar to that of younger groups. The above diagnoses should be kept in mind when dealing with middle‐aged heart patients. Twenty subjects had been previously treated under erroneous diagnoses, notably rheumatic, pulmonary or coronary heart diseases. The reasons were most often the finding of an apical diastolic murmur in patients with left‐to‐right shunt, a history of typical angina pectoris which occurred in 11 patients, or the presence of atrial fibrillation which altered the auscultatory signs, e.g. in atrial septal defect. Even if routine health control had led to the diagnosis in many cases there was a high incidence of troublesome symptoms, pulmonary hypertension and other complications. A comparison of younger and older adults showed a definite worsening of symptoms and complications in the latter group. Surgical treatment was carried out in 73 patients, 25 of whom had arrhythmia or failure before the operation. Six died in the postoperative period, but most patients showed definite improvement.