Development of mitral insufficiency following closure of ostium secundum atrial-septal defect

The development of severe mitral insufficiency after a successful closure of an ostium secundum ASD was encountered in four adult patients. This acquired postoperative lesion appeared nine years, three and a half years, two year, and two months following ASD repair. It was associated with deterioration of the excellent clinical improvement following closure of ASD, and was detected clinically by the appearance of a new apical holosystolic murmur. In one patient, pathologic examination of the mitral valve indicates insufficiency to be possibly due to rheumatic valvulitis. The cause of mitral insufficiency in the other patients is not clear. Multiple etiologies could be responsible for this unusual association.