Pulmonic stenosis and associated atrial septal defects in older patients: Report of three cases, including one with calcific pulmonic stenosis

Abstract Three cases of pulmonic stenosis associated with atrial septal defects in older patients are reported. One 59 year old man presented the additional rare finding of a severely calcified pulmonic valve. He is probably the oldest patient reported to have calcific pulmonic stenosis diagnosed fluoroscopically, cineangiographically and surgically. The forms of atrial septal defects included a patent foramen ovale with functioning right to left shunt in a 44 year old woman with severe pulmonic stenosis who died five months after open heart surgery of complications from recurrent tracheal stricture. A second form included an atrial septal defect of the sinus venosus type, associated with partial anomalous pulmonary venous return, in a patient with moderate calcific pulmonic stenosis. A third type of interatrial communication is described in a 69 year old man with moderate pulmonic stenosis, systemic hypertension and an atrial septal defect, probably of the secundum type. Factors responsible for survival to an older age group, and for valve calcification, are discussed.