Pulmonary hypertension occurs less frequently in atrial septal defect (A.S.D.) than in shunts at ventricular or aorto-pulmonary levels. Nevertheless it is a serious complication of A.S.D. that leads to severe disability, predisposes to pulmonary thrombosis, and constitutes the main contraindication to surgical closure of the defect. It is rare below the age of 20 and relatively common after the age of 40 years.This
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