Atrial septal defect in adults.

The treatment of the atrial septal defect (ASD) in patients older than 40 years of age is controversial. We analyzed our experience according to different subgroups: i) the natural history of adults without closure of the defect; ii) comparison between surgical closure versus no closure; and iii) comparison between surgical versus transcatheter occlusion. It was concluded that surgical treatment offers better results than medical treatment alone. According to our results, treatment must be undertaken as soon as possible, even when the functional symptoms seem to be minimal. The safety and efficacy of a transcatheter occluder system was superior to surgery with regard to some complications, although this difference was not significant in young adults (<40 years).