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Tricuspid regurgitation severity after atrial septal defect closure or pulmonic valve replacement
  1. Agustin C Martin-Garcia1,2,3,
  2. Konstantinos Dimopoulos1,2,
  3. Maria Boutsikou1,2,
  4. Ana Martin-Garcia3,
  5. Aleksander Kempny1,2,
  6. Rafael Alonso-Gonzalez1,2,
  7. Lorna Swan1,2,
  8. Anselm Uebing1,2,
  9. Sonya V Babu-Narayan1,2,
  10. Pedro Luis Sanchez3,
  11. Wei Li1,2,4,
  12. Darryl Shore1,2,
  13. Michael A Gatzoulis1,2
  1. 1 Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
  2. 2 National Heart and Lung Institute, Imperial College London, London, UK
  3. 3 Cardiology Department, University Hospital of Salamanca Instituto de Investigación Biomédica de Salamanca (IBSAL) Facultad de Medicina Universidad de Salamanca, CIBERCV, Salamanca, Spain
  4. 4 Department of Echocardiology, Royal Brompton Hospital, London, UK
  1. Correspondence to Dr Konstantinos Dimopoulos, Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London SW3 6NP, UK; k.dimopoulos02{at}


Objectives Cardiac surgery or catheter interventions are nowadays commonly performed to reduce volume loading of the right ventricle in adults with congenital heart disease. However, little is known, on the effect of such procedures on pre-existing tricuspid regurgitation (TR). We assessed the potential reduction in the severity of TR after atrial septal defect (ASD) closure and pulmonic valve replacement (PVR).

Methods Demographics, clinical and echocardiographic characteristics of consecutive patients undergoing ASD closure or PVR between 2005 and 2014 at a single centre who had at least mild preoperative TR were collected and analysed.

Results Overall, 162 patients (mean age at intervention 41.6±16.1 years, 38.3% male) were included: 101 after ASD closure (61 transcatheter vs 40 surgical) and 61 after PVR (3 transcatheter vs 58 surgical). Only 11.1% received concomitant tricuspid valve surgery (repair). There was significant reduction in the severity of TR in the overall population, from 38 (23.5%) patients having moderate or severe TR preoperatively to only 11 (6.8%) and 20 (12.3%) at 6 months and 12 months of follow-up, respectively (McNemar p<0.0001). There was a significant reduction in tricuspid valve annular diameter (p<0.0001), coaptation distance (p<0.0001) and systolic tenting area (p<0.0001). The reduction in TR was also observed in patients who did not have concomitant tricuspid valve (TV) repair (from 15.3% to 6.9% and 11.8% at 6 and 12 months, respectively, p<0.0001). On multivariable logistic regression including all univariable predictors of residual TR at 12 months, only RA area remained in the model (OR 1.2, 95% CI 1.04 to 1.37, p=0.01).

Conclusions ASD closure and PVR are associated with a significant reduction in tricuspid regurgitation, even among patients who do not undergo concomitant tricuspid valve surgery.

  • tricuspid valve disease
  • congenital heart disease surgery
  • tetralogy of fallot
  • interventional cardiology and endovascular procedures
  • atrial septal defect

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  • ACM-G and KD contributed equally.

  • Contributors All coauthors have agreed to, seen and approved the manuscript for its submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ACM-G has received support from the Instituto de Investigacion Biomedica de Salamanca (IBSAL). KD, AK and AM-G from the Royal Brompton Hospital have received unrestricted educational and research grants and acted as consultants for Bayer, Pfizer, Actelion and GSK. SVB-N was supported by the British Heart Foundation (FS/11/38/28864).

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.