Atrial septal defect ostium secundum natural history, complications and prognosis

Most individuals with an uncorrected secundum ASD are asymptomic or experience minimal symptoms through early adulthood. About 70% of all ostium secundum ASD patients’ develop symptoms by the time they are in their 40s. Symptom onset and severity is largely dependent upon the size of the defect. Without intervention prior to the development of Eisenmenger’s syndrome, the mortality rate for symptomatic adults is greater than 50%. Possible complications include atrial fibrillation, pulmonary hypertension and stroke.

As many atrial septal defect ostium secundum patients are asymptomatic, it is common to survive into adulthood without any need for intervention. Many atrial septal defects smaller than 8 mm in diameter close spontaneously during infancy. Spontaneous closure is uncommon in children and adults. During adulthood there can be the onset of symptoms and an altered life expectancy. Beyond 40-50 years of age, survival without intervention is under 50% with a mortality rate of about 6% per year.

Atrial septal defect ostium secundum is associated with complications such as

• Atrial fibrillation
• Pulmonary hypertension
• Heart failure
• Stroke

The prognosis for most atrial septal defect patients, especially prior to the age of 40, is positive. As atrial septal defect patients age, symptoms and complications may advance and influence quality of life. With surgical intervention, the mortality rate is less than 1% for atrial septal defect patients under 45. Surgical intervention in older populations is equally promising and can result in longer longevity and improvements in quality of life. Left untreated, the prognosis for atrial septal defect patients is significantly less favorable and may lead to earlier death.

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