The failure of the hole between the two atria to close after birth leads to a disorder called ASD primum. The most common problems with an opening found in the heart with Lutembachers syndrome is Ostium Secundum. Ostium Secundum is a hole that is found within the flap of tissue (septum primum) that will eventually close the hole between the two atria after birth. With either type of ASD, ASD will usually cause the blood flow from the right atrium to skip going to the right ventricle and instead flow to the left atrium. If mitral stenosis (the hardening of flap of tissue known as a valve which opens and closes between the left atrium and ventricle to control blood flow) is also present, blood will flow into the right atrium through the hole between the atria wall instead of flowing into the left ventricle and systemic circulation. Eventually this leads to other problems such as the right ventricle failing and a reduced blood flow to the left ventricle.In addition to the ASD, MS can either be acquired (present either from an episode of rheumatic fever or the mother has or had rheumatic fever during the pregnancy) or congenital (the child being born with the disorder). With the combination of both ASD and MS, the heart can be under severe strain as it tries to move blood throughout the heart and lungs.
Management
Currently, buccal exostoses do not commonly require treatment. If there is neither pain nor sensitivity, the buccal exostosis simply needs to be monitored with routine dental check-ups. Patients are given oral hygiene advice and are advised to cleanse above and below the growth with a mouthwash once a day to remove any food debris. Due to it being difficult to clean around the exostosis, periodontal disease can often occur as a result, and so this should be treated by the dentist or dental hygienist/therapist. There are, however, some occasions were treatment is required, for example;

If the skin overlying it is continually experiencing trauma due to sharp foods,
A prosthesis, such as a denture, is required and cannot be adapted to the exostosis,
The growth reaches an unmanageable size,
Aesthetic reasons.If the growth needs to be removed then a simple surgical procedure can be carried out under local anaesthetic with no recurrence in the long-term follow up. This is done by reflecting the mucoperiosteal flap in order to expose the extended bone for complete excision. This bone will then be sent for histopathological examination to differentiate from benign to malignant neoplastic processes. Routine post-operative instructions are given to the patient and occasionally antibiotics may be prescribed. The patient will then be recalled after 1 week in order to remove the sutures and often after a few months for post-operative follow up. Epidemiology
They are more common in males than females, occurring in a ratio of about 5:1. They are strongly associated with the presence of torus mandibularis and torus palatinus.