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Do not underestimate the impact of load and of remodelling capabilities of the right heart
  1. Erwan Donal1,
  2. Hirotsugu Yamada2
  1. 1Department of Cardiology, CHU Rennes, Rennes, Bretagne, France
  2. 2Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
  1. Correspondence to Dr Erwan Donal, Cardiology, CHU Rennes, Rennes, Bretagne, France; erwan.donal{at}

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Atrial septal defects (ASDs) are one of the most common adult congenital heart diseases.1 Independently, severe functional tricuspid regurgitation (TR) alone is a poor prognosticator independent of the degree of pulmonary arterial hypertension and left ventricular systolic function.2 The failure of tricuspid valve coaptation as a consequence of right heart pressure or volume overloading and/or annular dilation is associated with the occurrence of functional TR. Thus, TR can occur secondary to ASD-based volume overload due to right heart and tricuspid annular dilatation. Percutaneous ASD closure might be able to improve functional TR by reverse remodelling and to prevent further right heart deterioration from volume to eventual pressure overload.

The recognition of the clinical relevance of functional TR and of its active therapeutic management is currently advocated.3 Too often, significant TRs are accidently discovered. Tricuspid valve repair is considered in candidates for surgical ASD closure with annular diameter ≥40 mm. European and American guidelines recommend repair of functional TR as part of left-sided heart disease only; therefore, management of ASD-based TR remains undetermined. Simultaneous surgical ASD and TV repair is often performed. …

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  • 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 None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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