[Surgical closure of atrial septal defect--when is it too late?]

We describe a 41 year-old patient with atrial septal defect combined with mitral stenosis, severe pulmonary hypertension and tricuspid regurgitation. Despite high pulmonary vascular resistance, surgical intervention was decided on. Follow up proved to be successful. The role of echocardiography and hemodynamics data to establish a preoperative diagnosis is discussed.