Atrial septal defects are one of the common adult congenital heart diseases, most often detected incidentally during routine physical examinations, and in some cases detected through standardized cardiovascular physical examinations when other cardiovascular disease symptoms are present. In advanced stages, it can lead to abnormally high pulmonary artery pressure, and long-term abnormal shunting leads to cardiac enlargement and various forms of arrhythmia, mostly atrial arrhythmia. Atrial septal defects are sometimes associated with varying degrees of anomalous pulmonary venous connections. The pathophysiology of isolated anomalous pulmonary venous connections is similar to that of atrial septal defects, but an underlying right-to-left shunt is generally not present. Closure of the atrial septal defect is recommended in patients with evidence of right heart volume overload. Direct closure of the atrial septal defect is usually safe in patients without significant pulmonary hypertension on noninvasive testing, but in patients with pulmonary hypertension on noninvasive testing (e.g., ultrasound), refinement of the right cardiac catheterization (an interventional procedure used to measure and calculate pulmonary vascular resistance) is recommended for further evaluation of pulmonary vascular pressure and resistance. The patient’s pulmonary vascular pressure and resistance should be further evaluated. In patients with pulmonary vascular resistance of 3 to 5 WU (unit name wood), atrial isthmus closure (implying surgical opportunity) should be considered when there is a significant left-to-right shunt (Qp:Qs >1.5, which can be estimated by color ultrasound). For patients with pulmonary resistance ≥5WU, when pulmonary resistance <5wuqs="">1.5,color ultrasound can estimate this data) after targeted therapy for pulmonary hypertension, atrial defect open-window closure (i.e., the center of the atrial defect patch is left in the operation with a small hole of 3-4mm, and the large atrial defect is changed into a small atrial defect) should be considered, and for those who have Eisenmenger’s syndrome (Eisenmenger’s syndrome, which is generally accompanied by symptoms of pestle and mortar of the limbs, and cyanosis), they should be considered. In patients with Eisenmenger syndrome (Eisenmenger syndrome, usually with symptoms of cyanosis), pulmonary resistance ≥5 WU after targeted therapy for pulmonary hypertension, and hypoxia during exercise, closure of the atrial defect is not recommended (loss of surgical timing, lifelong medication and conservative medical treatment). Minimally invasive non-invasive closure of each intervention under non-extracorporeal circulation is preferred when conditions at the margins of the atrial defect permit (reasonable location of the atrial defect, assessed on the basis of ultrasound). Available follow-up data suggest that surgical and catheter interventions have similar success and mortality rates, but patients intervening via catheterization have lower morbidity and shorter hospital stays but slightly higher rates of reintervention. Surgical correction of isolated pulmonary venous connection anomalies may lead to venous thrombosis because of slow blood flow, and therefore the procedure should be performed by a surgeon specializing in precordial surgery. In patients with impaired left heart function and preoperative suggestion of mitral regurgitation (which can be demonstrated by ultrasound results) more careful judgment should be made regarding the possibility of closure of the atrial defect, which has been demonstrated to be safe and associated with reduced pulmonary artery pressures and symptomatic improvement in patients with pulmonary resistance <5 WU. However, even in this population, the degree of improvement decreases with increasing pulmonary artery pressure. Patients with pulmonary resistance ≥5 WU are unlikely to improve and may have worse outcomes with complete closure of the atrial defect. Concurrent radiofrequency ablation may be considered for arrhythmia management in patients who have combined clear evidence of atrial arrhythmias. In elderly patients, the risks and benefits of the procedure should be weighed to carefully determine the treatment strategy.