UNUSUAL CLINICAL PRESENTATIONS OF SECUNDUM ATRIAL SEPTAL-DEFECT

Atrial septal defect (ASD) is one of the most common congenital cardia c anomalies found in the adult population. Although usually asymptomat ic in childhood, ASD will be symptomatic in approximately 75 percent o f adults. The most common symptoms include fatigue, dyspnea on exertio n, and palpitations. However, the presentation of ASD can be protean. We present four patients with secundum ASD with unusual clinical manif estations. Patient 1 had moderately severe mitral regurgitation. Patie nt 2 had pulmonary edema with generalized left ventricular impairment. Patient 3 had chest pain typical of angina pectoris. Patient 4 had ri ght-to-left shunt following an orthopedic surgical procedure. These pa tients had chest radiographs and electrocardiograms typical of secundu m ASD, but their presentations were uncommon. In three of four of thes e patients, dramatic resolution of symptoms followed surgical repair o f their ASD.