In adult patients with atrial septal defect, although the y descent may be visible, the x' descent remains dominant. This is a result of the fact that the right ventricular volume overload provides a strong Starling effect augmenting its contraction (Fig. 25). In some adult patients with atrial septal defect, the pattern ofx' = y descent may be observed. This is usually due to large defects with equalization of the right atrial and the left atrial pressures with elevated RV diastolic pressures.
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