title: Closure of atrial septal defects in adult patients: justification of the "tipping point".
abstract: The "tipping point," favoring closure of hemodynamically significant atrial septal defects (ASDs) in the adult, has occurred and is supported by strong clinical data, especially in patients who present with symptoms. Echocardiographic evidence of right ventricular volume overload as a correlate of significant left-to-right intracardiac shunting remains a prerequisite to determine need for closure, even in patients with child-bearing potential. No patient appears too old to achieve benefit from closure of such defects. Modern therapeutics for pulmonary vascular disease may allow extension of these techniques to an increasingly threatened population, with care best coordinated and offered in appropriate centers of expertise.
authors.affiliation: Boston Adult Congenital Heart Service, Children's Hospital/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Landzber@cardio.tch.harvard.edu
authors.forename: M J
authors.initials: MJ
authors.lastname: Landzberg
mesh_terms: D000328:Adult; D006344:Heart Septal Defects, Atrial / Q000503:physiopathology* / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans