Perspective:

Secundum ASDs remain one of the most commonly diagnosed congenital heart defects in adulthood. However, there are few prospective randomized trials to guide management. Using the CONCOR database, the authors prospectively addressed whether gender had an affect on morbidity and mortality. Male gender not only had lower survival, but also more complications, including arrhythmias, cerebrovascular events, and heart failure. While females were more likely to have pulmonary hypertension associated with secundum ASD, males with pulmonary hypertension had a higher mortality. This study included both individuals who had surgical ASD closure as well as those who had not received an intervention. As the CONCOR database does not account for smoking, comorbidities, perioperative complications, or pulmonary arterial pressures or right ventricular dilation, the extension of this research to clinical management recommendations regarding potential advantages of ASD closure in adulthood is limited. However, the gender disparity in survival and morbidity demonstrated here does suggest the need to focus clinically and in future research on better understanding of why this disparity may exist. This research also highlights the growing burden of complications with age and heterogeneity of presentation and management needs in what was once thought to be a relatively low complexity diagnosis.