title: Predictors of mid-term functional tricuspid regurgitation after device closure of atrial septal defect in adults: Impact of pre-operative tricuspid valve remodeling.
abstract: BACKGROUND
  Functional TR occurs in adults with congenital atrial septal defect (ASD) due to left-to-right inter-atrial shunting and enlarged right heart. The prevalence and the predictors of TR following ASD closure in adults remain unknown. Moreover, whether preoperative anatomical parameters of tricuspid valve related to TR after ASD closure is understudied.
  
  
  METHODS
  Comprehensive transthoracic echocardiography was performed in 64 consecutive secundum ASD patients before and at 3 months after device closure. Tricuspid valve parameters [annulus diameter (TAD), tenting area, tenting height, distal tricuspid septal leaflet angle (TSLA)], right ventricular (RV) function, pulmonary arterial pressures and severity of TR were recorded. Post-closure TR was defined as PISA radius ≥ 6 mm at 3 months.
  
  
  RESULTS
  The TR severity was reduced after ASD closure with post-closure TR in 31 patients (48%) at follow-up. TR patients had larger ventricles, more TR, greater TAD, and larger tenting area/height and TSLA but similar RV long-axis function and pulmonary pressures at baseline. Pre-closure TAD [odds ratio (OR): 6.076, p=0.032] and TSLA (OR: 1.218, p=0.001) were the independent predictors for TR. A TAD >3.5 cm and a TSLA >30° had sensitivity, specificity, and area under the curve of 97%, 76%, and 0.82 and 100%, 78%, and 0.84, respectively. Assessment of TSLA showed an incremental value over TAD for predicting TR after closure (χ(2)=21.3 vs. 9.9, p<0.001).
  
  
  CONCLUSIONS
  Nearly half of adults had TR following device closure of ASD. It was related to the excessive pre-operative structural remodeling in tricuspid valve rather than changes in RV.
authors.affiliation: Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.affiliation: Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Cardiac Medical Unit, Grantham Hospital, Hong Kong.
authors.forename: Gabriel Wai-Kwok
authors.initials: GW
authors.lastname: Yip
authors.affiliation: Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. Electronic address: yylam@me.com.
authors.forename: Yat-Yin
authors.initials: YY
authors.lastname: Lam
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods; D004452:Echocardiography / Q000379:methods; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology*; D016278:Ventricular Function, Right / Q000502:physiology
keywords: Atrial septal defect; Distal tricuspid septal leaflet angle; Tricuspid regurgitation