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Persistent Tricuspid Regurgitation and Its Predictor in Adults After Percutaneous and Isolated Surgical Closure of Secundum Atrial Septal Defect

      The fate of functional tricuspid regurgitation (TR) after closure of a secundum atrial septal defect (ASD) without any corrective tricuspid valve (TV) surgery remains unclear. We investigated this and the predictors of persistent TR after ASD closure. Thirty-two consecutive patients with moderate or severe TR before ASD closure were examined. Of these, 23 underwent percutaneous ASD closure, and 9 underwent isolated surgical ASD closure. The left ventricular end-diastolic volume, left ventricular ejection fraction, right ventricular end-diastolic area, right ventricular fractional area change, right ventricular spherical index, right atrial area, TV annular diameter, TV tethering height, pulmonary artery systolic pressure, and pulmonary/systemic blood flow ratio were determined by echocardiography before and early after ASD closure. The color Doppler maximal jet area was used to assess the severity of TR. After ASD closure, the jet area decreased for all patients (p = 0.009); however, 16 patients (50%) had persistent TR. Multivariate analysis revealed that only pulmonary artery systolic pressure before ASD closure was related to the TR jet area after ASD closure (p = 0.003). A pulmonary artery systolic pressure of >60 mm Hg predicted persistent TR with 100% sensitivity and 63% specificity. In conclusion, functional TR was ameliorated after percutaneous and isolated surgical ASD closure, although persistent TR was common. The presence of pulmonary hypertension before ASD closure predicted persistent TR; therefore, corrective TV surgery should be considered at ASD closure in adult patients with moderate or severe TR and concomitant pulmonary hypertension.
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      References

        • Masura J.
        • Gavora P.
        • Podnar T.
        Long-term outcome of transcatheter secundum-type atrial septal defect closure using Amplatzer septal occluders.
        J Am Coll Cardiol. 2005; 45: 505-507
        • Butera G.
        • Carminati M.
        • Chessa M.
        • Youssef R.
        • Drago M.
        • Giamberti A.
        • Pome G.
        • Bossone E.
        • Frigiola A.
        Percutaneous versus surgical closure of secundum atrial septal defect: comparison of early results and complications.
        Am Heart J. 2006; 151: 228-234
        • Matsumori M.
        • Ito T.
        • Toyono M.
        • Harada K.
        • Takada G.
        Influence of right ventricular volume and pressure overloads on assessment of left ventricular volume using two-dimensional echocardiography in infants and children with congenital heart diseases.
        Am J Cardiol. 1997; 80: 965-968
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • Flachskampf F.A.
        • Foster E.
        • Pellikka P.A.
        • Picard M.H.
        • Roman M.J.
        • Seward J.
        • Shanewise J.S.
        • Solomon S.D.
        • Spencer K.T.
        • Sutton M.S.
        • Stewart W.J.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Fukuda S.
        • Gillinov A.M.
        • Song J.M.
        • Daimon M.
        • Kongsaerepong V.
        • Thomas J.D.
        • Shiota T.
        Echocardiographic insights into atrial and ventricular mechanisms of functional tricuspid regurgitation.
        Am Heart J. 2006; 152: 1208-1214
        • Fukuda S.
        • Song J.M.
        • Gillinov A.M.
        • McCarthy P.M.
        • Daimon M.
        • Kongsaerepong V.
        • Thomas J.D.
        • Shiota T.
        Tricuspid valve tethering predicts residual tricuspid regurgitation after tricuspid annuloplasty.
        Circulation. 2005; 111: 975-979
        • Zoghbi W.A.
        • Enriquez-Sarano M.
        • Foster E.
        • Grayburn P.A.
        • Kraft C.D.
        • Levine R.A.
        • Nihoyannopoulos P.
        • Otto C.M.
        • Quinones M.A.
        • Rakowski H.
        • Stewart W.J.
        • Waggoner A.
        • Weissman N.J.
        Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.
        J Am Soc Echocardiogr. 2003; 16: 777-802
        • Yock P.G.
        • Popp R.L.
        Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation.
        Circulation. 1984; 70: 657-662
        • Kircher B.J.
        • Himelman R.B.
        • Schiller N.B.
        Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava.
        Am J Cardiol. 1990; 66: 493-496
        • Dittmann H.
        • Jacksch R.
        • Voelker W.
        • Karsch K.R.
        • Seipel L.
        Accuracy of Doppler echocardiography in quantification of left to right shunts in adult patients with atrial septal defect.
        J Am Coll Cardiol. 1988; 11: 338-342
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Kort H.W.
        • Balzer D.T.
        • Johnson M.C.
        Resolution of right heart enlargement after closure of secundum atrial septal defect with transcatheter technique.
        J Am Coll Cardiol. 2001; 38: 1528-1532
        • Koelling T.M.
        • Aaronson K.D.
        • Cody R.J.
        • Bach D.S.
        • Armstrong W.F.
        Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction.
        Am Heart J. 2002; 144: 524-529
        • Nath J.
        • Foster E.
        • Heidenreich P.A.
        Impact of tricuspid regurgitation on long-term survival.
        J Am Coll Cardiol. 2004; 43: 405-409
        • McCarthy P.M.
        • Bhudia S.K.
        • Rajeswaran J.
        • Hoercher K.J.
        • Lytle B.W.
        • Cosgrove D.M.
        • Blackstone E.H.
        Tricuspid valve repair: durability and risk factors for failure.
        J Thorac Cardiovasc Surg. 2004; 127: 674-685
        • Vogel M.
        • Berger F.
        • Kramer A.
        • Alexi-Meshkishvili V.
        • Lange P.E.
        Incidence of secondary pulmonary hypertension in adults with atrial septal or sinus venosus defects.
        Heart. 1999; 82: 30-33
        • Steele P.M.
        • Fuster V.
        • Cohen M.
        • Ritter D.G.
        • McGoon D.C.
        Isolated atrial septal defect with pulmonary vascular obstructive disease—long-term follow-up and prediction of outcome after surgical correction.
        Circulation. 1987; 76: 1037-1042
        • Webb G.
        • Gatzoulis M.A.
        Atrial septal defects in the adult: recent progress and overview.
        Circulation. 2006; 114: 1645-1653
        • Schamroth C.L.
        • Sareli P.
        • Pocock W.A.
        • Davidoff R.
        • King J.
        • Reinach G.S.
        • Barlow J.B.
        Pulmonary arterial thrombosis in secundum atrial septal defect.
        Am J Cardiol. 1987; 60: 1152-1156
        • Attie F.
        • Rosas M.
        • Granados N.
        • Zabal C.
        • Buendia A.
        • Calderon J.
        Surgical treatment for secundum atrial septal defects in patients >40 years old: a randomized clinical trial.
        J Am Coll Cardiol. 2001; 38: 2035-2042
        • Engelfriet P.M.
        • Duffels M.G.
        • Moller T.
        • Boersma E.
        • Tijssen J.G.
        • Thaulow E.
        • Gatzoulis M.A.
        • Mulder B.J.
        Pulmonary arterial hypertension in adults born with a heart septal defect: the euro heart survey on adult congenital heart disease.
        Heart. 2007; 93: 682-687
        • Campbell M.
        Natural history of atrial septal defect.
        Br Heart J. 1970; 32: 820-826
        • Gomez-Moreno S.
        • Lage E.
        • Hernandez A.
        • Campos A.
        • Cabezon S.
        • Ordonez A.
        • Hinojosa R.
        Use of oral sildenafil in patients with irreversible pulmonary hypertension not eligible for heart transplantation.
        Transplant Proc. 2005; 37: 1550-1551