I'm 34 & have a small/moderate atrial septal defect. do these defects always get worse over time? my doc says my defect is "borderline" for closure.

No: May stay same and have minimal flow impact. The other concern with congenital defects is bacteremia and infection but less with asd paradoxical embolism is also a rare complication. Follow the md advice and echo follow up.

Worrisome finding: As a pediatrician i try to make sure i identify these early & most will be repaired by school age. A local associates wife had a mild stroke from a clot that slipped through one at 38, so i'm sensitive to the issue. Small defects can often be closed through a catheter with a special umbrella like device & i would wonder why you've not had this done already.

Not all need closure: Atrial septal defects are one of the most common congenital defects. Many people who have them will never have any impact from them. Closure may be needed if: 1) there is enough flow through to cause significant heart/lung changes 2) the ASD causes a neurological event (stroke or tia) 3) other rarer complications that can be traced back to the asd see and follow a cardiologist's advice.

Don't Always Worsen: Glad to hear you're seeing a doc. Asds do not always worsen. Many stay the same. But even if they stay the same, they can lead to problems with blood flow to your lungs. Continue to see your doctor. Your future echos, physical findings, and symptoms will evolve and help determine what to do (if anything at all).