Surgery is indicated for most patients with atrial septal defects, and, with but few exceptions, the defect is surgically correctable. Once the diagnosis has been made, all patients with symptoms should have an operation, with the exception of those with pulmonary hypertension grave enough to produce a shunt principally from right to left, rather than the usual left-to-right shunt, and with the probable exception of those with low defects. There are a number of possible techniques to perform this surgical procedure; nonetheless, the current trend favors open rather than closed operations.
Lewis FJ, Winchell P, Bashour FA. OPEN REPAIR OF ATRIAL SEPTAL DEFECTSRESULTS IN SIXTY-THREE PATIENTS. JAMA. 1957;165(8):922–927. doi:10.1001/jama.1957.02980260008002
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