Congenital atrial septal defect repair is safe and effective in patients of almost any age. Long-term survival among adults is excellent, although children generally appear to fare even better. Our 25-year study of outcomes among adults who underwent suture or patch closure found that survival exceeded 90%. We discuss our observations on use of transesophageal echocardiography, indications for cardiac catheterization, and continuing questions about atrial septal defect in adults.