Natural history of atrial septal defect with criteria for selection for surgery^*

An analysis of the clinical picture and natural history of uncomplicated atrial septal defect of the secundum type has been presented. In view of a shortened life expectancy, it is clear that corrective surgery should be undertaken in almost all cases. Only the presence of severe pulmonary hypertension with reversal of shunt, complex associated cardiac anomalies, or severe associated disease as in the elderly constitute contraindications to closure of the defect. Although the optimal age for repair is said to be 5 to 15 years, surgery prior to that time and through the sixth decade has been proved feasible and lifesaving.