Abstract
Although the median survival of unoperated patients with ASD is 36 years,3 survival beyond age 70 is not uncommon.4 Associated tricuspid insufficiency is probably the result of right ventricular enlargement and dilation of the tricuspid anulus. The direction of the shunt in an ASD is ultimately a function of ventricular compliance, and the degree of left-to-right shunt in this patient was probably not significant until aortic stenosis worsened to the extent that left ventricular compliance declined. Acquired aortic stenosis in association with ASD has not previously been reported. Operative mortality for ASD repair in patients over 60 is about 6% ,4, 5 and subsequent survival is equal with that of age-matched controls.6 Advanced age alone does not correlate with a poor surgical outcome, and this patient exemplifies the remarkable improvement that can be observed.
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