One hundred and four patients with congenital heart disease and over the age of 40 years have been visited the Second Department of Internal Medicine, Gunma University Hospital during the last 11 years. The most frequent lesion was the atrial septal defect of secundum type (72 cases) which was followed by ventricular septal defect (12 cases) and patent ductus arteriosus (7 cases). Forty eight of the above cases were first pointed out the cardiac abnormalities at the age of 40 years or later, while a correct diagnosis of congenital heart disease had been made only in 14 cases before.
The numbers of the disabled patients increased with the advancing age. Three fourths of the elderly patients over the age of 60 years were classified as being NYHA function class III or IV. Significant positive correlations were demonstrated between the age and the cardio-thoracic ratio and between the age and the right ventricular systolic pressure in atrial septal defect.
The clinical course of 68 cases followed for 2 years or longer were rather favorable under proper medical care. Only 3 died, while 9 cases without any medical supervisions were deteorirated. The course of 17 operated cases were good. Although an appropriate medical care is effective to relieve the symptoms, we thought that the surgical interventions should not be hesitated in middle-aged and even in elderly patients with congenital heart disease if indicated.