A 79-year-old man with atrial septal defect (ASD) and tricuspid regurgitation was successfully operated upon. Preoperative examinations showed atrial fibrillation, moderate pulmonary hypertension and lung dysfunction. Direct closure of the ASD accompanying with tricuspid annuloplasty was performed. Postoperative administration of catecholamines continued for twenty-six days to maintain hemodynamics. An intratracheal tube was extubated two days after the operation. However, an additional respiratory support using a nasal continuous positive airway pressure method was required for six days. His postoperative physical activity has been improved with class I of the New York Heart Association classification. Surgical intervention may be the treatment of choice for aged patients over 70 years with an ASD.