ABSTRACT • Background: Atrial septal defect (ASD) is a common congenital heart disease in newborns and infants. However, it has not been studied widely in the adult population. The present study is set to analyze the incidence, symptoms and echocardiographic findings in adults with ostium secundum atrial septal defect (OSASD), and to compare all variables between patients who underwent surgical closure and patients who did not undergo surgery but kept on optimal medical treatment. Methods: A total of 6461consecutive adult patients who underwent diagnostic transthoracic echocardiography were evaluated. For a better image quality and in case of nondiagnostic study, 22 patients underwent a transesophageal echocardiography. Results: There were thirty (0.46%) patients with OSASD. Of them, 80% were symptomatic. Patients who did not undergo surgical correction were older, had more comorbidities, and were more symptomatic as compared to those who underwent surgical correction (p-value < 0.05). Patients who underwent surgical correction had lower systolic pulmonary artery pressure (SPAP) (41 ± 9 mmHg vs. 58 ± 12 mmHg, p-value < 0.0001), maximum width of color flow signal (MWCFS) (1.6 ± 0.6 cm vs. 2.8 ± 0.7 cm, p-value < 0.0001) and right ventricular/left ventricular (RV/LV ratio) (0.76 ± 0.22 vs. 1.33 ± 0.27, p-value < 0.0001) when compared to patients without surgery. An increase in MWCFS and SPAP demonstrated a linear increase in RV/LV ratio. Similarly, an increase in MWCFS proportionally correlated with an increase in SPAP (p-value < 0.0001). Surgery was performed on 16 patients who belonged to all age groups.There were no reported complications or mortality. All patients who underwent surgery reported a significant improvement in their functional status during a 2-year follow-up. Conclusion: OSASD is a rare finding during adult serial diagnostic echocardiographies. Symptoms, atrial fibrillation and pulmonary hypertension increase with age.Surgical closure can be performed at any age as long as it is safe and is superior to medical therapy in symptoms improvement.

Keywords: atrial septal defect; adult congenital heart disease; echocardiography