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Adverse effect of surgical repair of an atrial septal defect in a patient with associated left ventricular disease.

The case of a seven-year-old child with atrial septal defect and associated left ventricular disease is presented. Following surgical repair of the defect, her condition deteriorated and she died of progressive heart failure. It is postulated that prior to operation the atrial septal defect provided a mechanism for decompression of the left atrium. After removal of this protective mechanism, the left ventricular disease was manifested by increased left atrial and pulmonary capillary pressure leading to her death. Such a course of events in a child is unusual and illustrates the difficulty in assessing left ventricular function in patients with atrial septal defect.