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Clinical, haemodynamic and follow-up data are presented for a group of 49 patients with atrial septal defect who first presented between the ages of 50 and 79. The incidence of supraventricular arrhythmias, pulmonary vascular disease and "heart failure" all increased with increasing age. Those who had the defect closed tended to be the more symptomatic and surgery resulted in symptomatic improvement in almost all. The combined early and late surgical mortality was 6.6%. Surgery appears to be of benefit in symptomatic patients below the age of 70. Above this age our small experience would suggest caution in recommending closure of the defect.
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