[Atrial septal defect in the aged (author's transl)]

Area of Science:

• Cardiology
• Congenital Heart Disease
• Geriatric Medicine

Context:

• The natural history of congenital heart disease (CHD) in aging populations is complex due to early surgical repairs.
• Untreated atrial septal defects (ASDs) in adults present a unique opportunity to study CHD progression.
• Assessing the long-term clinical and hemodynamic impact of non-operated ASDs is crucial for understanding aging with CHD.

Purpose:

• To delineate the natural history and clinical progression of untreated atrial septal defects in patients over 60 years old.
• To compare the hemodynamic and clinical status of older adults (≥60 years) with ASDs to a younger adult group (40-59 years).
• To identify age-related changes and signs of deterioration in non-operated ASD patients.

Summary:

• The study analyzed 103 patients with atrial septal defects, including 27 individuals over 60 years old, with clinical data supplemented by catheterization in 80 patients.
• Older patients (≥60 years) demonstrated statistically significant signs of increased right-ventricular overload on ECG, more frequent cardiac arrhythmias (primarily atrial fibrillation), and worsening chest X-ray findings.
• Progressive pulmonary hypertension was observed with increasing age in patients with untreated ASDs, even with intensive medical management.

Impact:

• Provides critical insights into the long-term natural history of untreated congenital heart disease in an aging population.
• Highlights the importance of monitoring for right-ventricular strain and pulmonary hypertension in older adults with atrial septal defects.
• Informs clinical management strategies and the potential need for intervention in elderly patients with unrepaired ASDs.