Natural history of secundum atrial septal defect in adults after medical or surgical treatment: a historical prospective study.

OBJECTIVE To compare outcome in patients with medically treated secundum atrial septal defect (ASD) first diagnosed after the age of 25 with the long-term outcome in a similar group of patients after surgical closure. DESIGN A historical, prospective, unrandomised study. SETTING A tertiary referral centre. PATIENTS All patients with ASD followed up since 1955 who fulfilled the entry criteria and had reached a current age of over 45 years--that is, 34 medical and 48 surgical patients with a mean follow up of 25 years. MAIN OUTCOME MEASURES Survival, symptoms, and complications. RESULTS There was no difference in survival or symptoms between the two groups and no difference in the incidence of new arrhythmias, stroke or other embolic phenomena, or cardiac failure. No patient in either group developed progressive pulmonary vascular disease. CONCLUSION Outcome in adults with ASD was not improved by surgical closure. Because progressive pulmonary vascular disease did not develop in any of these patients its prevention is not a reason for advising closure of ASD in adults.